How do bacteraemic patients present to the emergency department and what is the diagnostic validity of the clinical parameters; temperature, C-reactive protein and systemic inflammatory response syndrome?

Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine

Annmarie Touborg Lassen²  Pernille Just Vinholt¹  Court Pedersen⁴  Hans Jørn Kolmos³  Thøger Gorm Jensen³  Stig Lønberg Nielsen⁴  Daniel Pilsgaard Henriksen²  Katrine Prier Lindvig² 

[1] Department of Clinical Biochemistry and Pharmacology, Odense University Hospital, Sdr. Boulevard 29, 5000 Odense C, Denmark;Department of Emergency Medicine, Odense University Hospital, Sdr. Boulevard 29, 5000 Odense C, Denmark;Department of Clinical Microbiology, Odense University Hospital, Sdr. Boulevard 29, 5000 Odense C, Denmark;Department of Infectious Diseases, Odense University Hospital, Sdr. Boulevard 29, 5000 Odense C, Denmark

关键词: Systemic inflammatory response syndrome;    Temperature;    C-reactive protein;    Emergency medicine;    Bacteraemia;   

Others  :  1152256
DOI  :  10.1186/1757-7241-22-39

 received in 2013-10-02, accepted in 2014-06-25,  发布年份 2014

【 摘 要 】

Objective

Although blood cultures are often ordered based on the presence of fever, it is a clinical challenge to identify patients eligible for blood cultures. Our aim was to evaluate the diagnostic value of temperature, C-reactive-protein (CRP), and Systemic Inflammatory Response Syndrome (SIRS) to identify bacteraemic patients in the Medical Emergency Department (MED).

Methods

A population-based cohort study including all adult patients at the MED at Odense University Hospital between August 1st 2009 - August 31st 2011.

Results

11,988 patients were admitted to the MED within the study period. Blood cultures were performed on 5,499 (45.9%) patients within 2 days of arrival, of which 418 (7.6%) patients were diagnosed with bacteraemia. This corresponded to 3.5% of all patients. 34.1% of the bacteraemic patients had a normal rectal temperature (36.0°–38.0°C) recorded at arrival, 32.6% had a CRP < 100 mg/L and 28.0% did not fulfil the SIRS criteria.

For a temperature cut-point of >38.0°C sensitivity was 0.64 (95% CI 0.59–0.69) and specificity was 0.81 (0.80–0.82) to identify bacteraemic patients.

Conclusion

One third of the acute medical bacteraemic patients had a normal temperature at arrival to the MED. A normal temperature combined with a CRP < 100 mg/L and no SIRS criteria, ruled out bacteraemia.

【 授权许可】

   
2014 Lindvig et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

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