Predicting bacteremia in hospitalized patients: a prospectively validated model

Article Abstract:

Septicemia, the infection of the blood with microorganisms, is associated with a death rate of 40 to 50 percent in the US. Although blood is frequently tested for bacteria, 5 percent of tests yield true positive results, and 1.5 to 4.5 percent of tests yield false positive results. False positives may result from contaminating substances and lead to increased testing, duration of hospital stay, and inappropriate treatment. There is limited knowledge about the factors that predict the development of bacteremia, infection of the blood with bacteria. The frequency of true-positive and false-positive blood test results was assessed, and a model for predicting the rate of bacteremia in hospitalized patients was developed. In addition, groups of patients with a low likelihood of developing bacteremia, but with positive blood tests were identified. Of 1,007 tests for bacteria in the blood, 74 were true-positive and 81 were false-positive. Factors that predicted the development of bacteremia included a temperature of 38.8 degrees Centigrade, the presence of fatal disease, shaking chills, intravenous drug abuse, severe and sudden abdominal pain, and accompanying disease. In the low-risk group, which was identified by the absence of these predictive factors, the predictive value of a positive result from blood culture tests was only 14 percent. In the high-risk group, 16 percent of blood culture tests were truly positive for bacteremia. The model showed that the rate at which low-risk patients were misclassified with bacteremia was 2 percent. This model may be useful in identifying patients at risk for developing bacteremia and in helping to determine the need for blood culture tests and antibiotic therapy. (Consumer Summary produced by Reliance Medical Information, Inc.)

Models, Risk factors, Diseases, Bacteremia

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Health values of the seriously ill

Article Abstract:

Seriously ill patients may vary greatly in the degree to which they value health and life, and their values may be higher than their surrogate caretakers think. A study of 1438 seriously ill patients with one of nine diseases and a six-month mortality rate of 50%, their caretakers, and their physicians analyzed the time-tradeoff utility, a measure of a person's preference for quality rather than quantity of life, to determine the strength of their health values. Health values varied widely among patients, suggesting that decision making concerning an individual patient take into account that individual's value of health, not some group norm. Health values were related to just a few other preference and health status measures. Health values increased over time.

Beliefs, opinions and attitudes, Critically ill

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A critical pathway for management of patients with acute chest pain who are at low risk for myocardial ischemia: recommendations and potential impact

Article Abstract:

A strategy for determining appropriate treatment options for patients with chest pain who have a low risk of heart attack may be safe and cost-effective. This strategy, called a critical pathway, was analyzed for 1,152 low-risk patients admitted to the hospital with chest pain. Nearly all of these patients had no further complications during their hospital stay. Careful observation followed by an exercise stress test could have safely reduced the number and length of hospital admissions among these patients.

Care and treatment, Ischemia, Chest pain

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