Abstract
Objective: Many studies have described constructing a prediction model for bacteremia in community-acquired pneumonia (CAP), but these studies were not validated in external heterogeneous groups. The objective of this study was to test the generalizability of a previous bacteremia prediction model for CAP by external validation. Methods: This multicenter retrospective cohort analysis was performed in eight tertiary urban hospital emergency departments (EDs). We reviewed adult patients who were hospitalized after presentation to the ED with CAP. We categorized the enrolled patients into three groups according to the bacteremia prediction model score and calculated the number of patients with or without a blood culture–positive result. We performed a multivariable analysis to identify significant predictors for bacteremia. Results: Among the enrolled 2,001 patients, 1,592 (79.6%), 371 (18.5%), and 38 (1.9%) were stratified to a low-, moderate-, and high-risk group, respectively, and this proportion was similar with previous study. Each group had a bacteremia-positive rate as follows: 1.2% for the low-risk group, 7.2% for the moderate-risk group, and 31.5% for the high-risk group. The area under the receiver operating characteristic curve for the bacteremia model in the external validation cohort was 0.81, and there was no significant difference with that of the previous internal validation cohort (p = 0.246). Assuming that blood cultures were not performed in the low-risk patients, the sensitivity and specificity of this model were 0.68 and 0.81, respectively. Additionally, the positive predictive value and negative predictive value were 9.54 and 98.87%, respectively. A platelet count less than 130 × 109 cells/L, albumin less than 3.3 mg/dL, and C-reactive protein greater than 17 mg/dL were identified as significant predictors with a sensitivity and specificity of 0.70 and 0.83, respectively. Conclusion: The bacteremia prediction model was well validated in the general population and could help physicians make the decision to reduce the number of blood cultures in patients with CAP.
| Original language | English |
|---|---|
| Pages (from-to) | 1226-1234 |
| Number of pages | 9 |
| Journal | Academic Emergency Medicine |
| Volume | 24 |
| Issue number | 10 |
| DOIs | |
| State | Published - Oct 2017 |
Bibliographical note
Funding Information:From the Department of Emergency Medicine, Seoul National University Bundang Hospital (BK, KK, SJ), Gyeonggi-do; the Department of Emergency Medicine, Mediplex Sejong Hospital (JC), Incheon; the Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine (TGS), Seoul; the Department of Emergency Medicine, University of Ulsan College of Medicine, Asan Medical Center (WYK), Seoul; the Department of Emergency Medicine, Korea University College of Medicine, Guro Hospital (JYK), Seoul; the Department of Emergency Medicine, Yonsei University College of Medicine (YSP, JSY, SPC), Seoul; the Department of Emergency Medicine, College of Medicine, The Catholic University of Korea (SHK), Seoul; the Department of Emergency Medicine, Seoul National University Boramae Medical Center (HJL, JS), Seoul; and the Department of Emergency Medicine, Seoul National University Hospital (KSK), Seoul, Korea. Received May 24, 2017; revision received July 10, 2017; accepted July 12, 2017. BK and JC contributed equally to the manuscript. This study was supported by the Seoul National University Bundang Hospital Research Fund grant 11-2017-038. The authors have no potential conflicts to disclose. Supervising Editor: Alan E. Jones, MD. Address for correspondence and reprints: Kyuseok Kim; e-mail: [email protected]. ACADEMIC EMERGENCY MEDICINE 2017;24:1226–1234.
Publisher Copyright:
© 2017 by the Society for Academic Emergency Medicine