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Development and validation of a screening tool for early identification of bloodstream infection in older patients - a retrospective case-control study.

ABSTRACT: BACKGROUND:Delayed diagnosis of bloodstream infection (BSI) occurs in >?20% of older patients, with misdiagnosis in 35%. Our objective was to develop and validate a clinically useful screening tool to identify older patients with a high probability of having a BSI. METHODS:Hospitalized patients >?80?years old with BSI (n =?105/group) were evaluated for the tool development in this retrospective matched case-controlled study (learn cohort). The tool was validated in different retrospectively matched case and control patients >?80?years old (n =?120/group) and 65 to 79?years old (n =?250/group) (test cohort). Binary logistic regression was used to develop a screening tool using laboratory and clinical parameters that were significantly associated with BSI (P ?1); and Classification and Regression Tree (CART) analysis was used to identify parameter breakpoints. Performance metrics were used to evaluate and validate the tool. RESULTS:The significant parameters associated with BSI were maximum temperature (Tmax)(>?37.55C)(OR?=?42.575), neutrophils (>?7.95)(OR?=?1.923), a change in level of consciousness (LOC) (Yes?=?1, No?=?0)(OR?=?1.571), blood urea nitrogen (BUN)(>?10.05)(OR?=?1.359), glucose (>?7.35)(OR?=?1.167), albumin (?19.5)(OR?=?1.005). The optimal screening tool [Ln (odds of BSI)?=?-?150.299?+?3.751(Tmax)?+?0.654(neutrophils)?+?0.452(change in LOC)?+?0.307(BUN)?+?0.154(glucose)?+?0.038(albumin)?+?0.005(ALT)] had favorable performance metrics in the learn and test cohorts (sensitivity, specificity and accuracy of 95% in the learn cohort and 77, 89, and 81% in the total test cohort); and performed better than using only temperature and neutrophil count. CONCLUSIONS:The validated tool had high predictive value which may improve early identification and management of BSI in older patients.

SUBMITTER: Walker SAN

PROVIDER: S-EPMC6942330 | biostudies-literature | 2020 Jan

REPOSITORIES: biostudies-literature

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Development and validation of a screening tool for early identification of bloodstream infection in older patients - a retrospective case-control study.

Walker Sandra A N SAN Bannerman Heather H Ma Nathan N Peragine Christine C Elligsen Marion M Palmay Lesley L Williams Evelyn E Liu Barbara B

BMC geriatrics 20200103 1

<h4>Background</h4>Delayed diagnosis of bloodstream infection (BSI) occurs in > 20% of older patients, with misdiagnosis in 35%. Our objective was to develop and validate a clinically useful screening tool to identify older patients with a high probability of having a BSI.<h4>Methods</h4>Hospitalized patients > 80 years old with BSI (n = 105/group) were evaluated for the tool development in this retrospective matched case-controlled study (learn cohort). The tool was validated in different retro ...[more]

PMID: 31900110

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Dataset Information

Development and validation of a screening tool for early identification of bloodstream infection in older patients - a retrospective case-control study.

Publications

Development and validation of a screening tool for early identification of bloodstream infection in older patients - a retrospective case-control study.

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