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An external validation study of a clinical prediction rule for medical patients with suspected bacteraemia

An external validation study of a clinical prediction rule for medical patients with suspected bacteraemia
An external validation study of a clinical prediction rule for medical patients with suspected bacteraemia
Objective: The objective of this study was to externally validate a clinical prediction rule (CPR)—the ‘Shapiro criteria’—to predict bacteraemia in an acute medical unit (AMU).

Methods: Prospectively collected data, retrospectively evaluated over 11?months in an AMU in the UK. From 4810 admissions, 635 patients (13%) had blood cultures (BCs) performed. The 100 cases of true bacteraemia were compared with a randomly selected sample of 100 control cases where BCs were sterile.

Results: To predict bacteraemia (at a cut-off score of two points), the Shapiro criteria had a sensitivity of 97% (95% CIs 91% to 99%), specificity 37% (28% to 47%), positive likelihood ratio 1.54 (1.3 to 1.8) and a negative likelihood ratio of 0.08 (0.03 to 0.25). The area under the receiver operating curve was 0.80 (0.74 to 0.86), and the Hosmer–Lemeshow p value was 0.45.

Conclusions: A cut-off score of two points on the Shapiro criteria had high sensitivity to predict bacteraemia in a study of acute general medical admissions. Application of the rule in patients being considered for a BC could identify those at low risk of bacteraemia. Though the model demonstrated good discrimination, the lengthy number of variables (13) and difficulty automating the CPR may limit its use.
1472-0205
124-129
Hodgson, Luke Eliot
202f8157-7783-471c-b629-3f1451b2e442
Dragolea, Nicholas
57fe8de4-1810-4f2a-8bd8-a59a2738aae3
Venn, Richard
adc24ece-fb8d-4c1e-969b-026ca62db4ec
Dimitrov, Borislav D.
366d715f-ffd9-45a1-8415-65de5488472f
Forni, Lui G.
e9ca402c-ea28-4d1a-8c4f-7fbaf205bad8
Hodgson, Luke Eliot
202f8157-7783-471c-b629-3f1451b2e442
Dragolea, Nicholas
57fe8de4-1810-4f2a-8bd8-a59a2738aae3
Venn, Richard
adc24ece-fb8d-4c1e-969b-026ca62db4ec
Dimitrov, Borislav D.
366d715f-ffd9-45a1-8415-65de5488472f
Forni, Lui G.
e9ca402c-ea28-4d1a-8c4f-7fbaf205bad8

Hodgson, Luke Eliot, Dragolea, Nicholas, Venn, Richard, Dimitrov, Borislav D. and Forni, Lui G. (2016) An external validation study of a clinical prediction rule for medical patients with suspected bacteraemia. Emergency Medicine Journal, 33 (2), 124-129. (doi:10.1136/emermed-2015-204926). (PMID:26246024)

Record type: Article

Abstract

Objective: The objective of this study was to externally validate a clinical prediction rule (CPR)—the ‘Shapiro criteria’—to predict bacteraemia in an acute medical unit (AMU).

Methods: Prospectively collected data, retrospectively evaluated over 11?months in an AMU in the UK. From 4810 admissions, 635 patients (13%) had blood cultures (BCs) performed. The 100 cases of true bacteraemia were compared with a randomly selected sample of 100 control cases where BCs were sterile.

Results: To predict bacteraemia (at a cut-off score of two points), the Shapiro criteria had a sensitivity of 97% (95% CIs 91% to 99%), specificity 37% (28% to 47%), positive likelihood ratio 1.54 (1.3 to 1.8) and a negative likelihood ratio of 0.08 (0.03 to 0.25). The area under the receiver operating curve was 0.80 (0.74 to 0.86), and the Hosmer–Lemeshow p value was 0.45.

Conclusions: A cut-off score of two points on the Shapiro criteria had high sensitivity to predict bacteraemia in a study of acute general medical admissions. Application of the rule in patients being considered for a BC could identify those at low risk of bacteraemia. Though the model demonstrated good discrimination, the lengthy number of variables (13) and difficulty automating the CPR may limit its use.

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More information

Accepted/In Press date: 6 July 2015
e-pub ahead of print date: 5 August 2015
Published date: February 2016
Organisations: Primary Care & Population Sciences

Identifiers

Local EPrints ID: 390163
URI: https://eprints.soton.ac.uk/id/eprint/390163
ISSN: 1472-0205
PURE UUID: 0e8d15ac-1376-4a59-bbf6-20aa946e0dc0

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Date deposited: 21 Mar 2016 14:53
Last modified: 04 Nov 2019 19:56

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