Tokuda Y, Miyasato H, Stein G H
Department of Medicine, Okinawa Chubu Hospital, Japan.
QJM. 2005 Nov;98(11):813-20. doi: 10.1093/qjmed/hci120. Epub 2005 Sep 20.
Existing prediction models for the risk of bacteraemia are complex and difficult to use. Physicians are likely to use a model only if it is simple and sensitive.
To develop a simple classification algorithm predicting the risk of bacteraemia.
Hospital-based study.
We enrolled 526 adult consecutive patients with acute febrile illness (40 with bacteraemia) presenting to the emergency department at a community hospital in Okinawa, Japan. Recursive partitioning analysis was used to build the classification algorithm with V-fold cross-validation. We used two clinical scenarios: in the first, laboratory tests were not available; in the second, they were.
The two prediction algorithms generated three different risk groups for bacteraemia. In the first scenario, the important variables were chills, pulse, and physician diagnosis of a low-risk site. The low-risk group from this first algorithm included 68% of the total patients; sensitivity was 87.5% and the misclassification rate was 1.4% (5/358). In the second scenario, the important variables were chills, C-reactive protein, and physician diagnosis of a low-risk site. The low-risk group for the second algorithm included 62% of the total patients; sensitivity was 92.5% and misclassification rate 0.9% (3/328). The algorithms had negative predictive values of 98.6% (first scenario) and 99.1% (second).
This simple and sensitive prediction algorithm may be useful for identifying patients at low risk of bacteraemia. Prospective validation is needed in other settings.
