Bacteremia Prediction With Prognostic Scores and a Causal Probabilistic Network- A Cohort Study of Emergency Department Patients

Background: Physicians tend to overestimate patients' pretest probability of having bacteremia. The low yield of blood cultures and contaminants is associated with significant financial cost, as well as increased length of stay and unnecessary antibiotic treatment. Objective: This study examined the abilities of the National Early Warning Score (NEWS), the Quick Sequential Organ Failure Assessment (qSOFA), the Modified Sequential Organ Failure Assess-ment (mSOFA), and two versions of the causal probabilistic network, SepsisFinderTM (SF) to predict bacteremia in adult emergency department (ED) patients. Methods: This cohort study included adult ED patients from a large urban, aca-demic tertiary hospital, with blood cultures obtained within 24 h of admission between 2016 and 2017. The outcome mea-sure was true bacteremia. NEWS, qSOFA, mSOFA, and the two versions of SF score were calculated for all patients based on the first available full set of vital signs within 2 h and laboratory values within 6 h after drawing the blood cultures. Area under the receiver operating characteristic curve (AUROC) was calculated for each scoring system. Re-sults: The study included 3106 ED patients, of which 199 (6.4%) patients had true bacteremia. The AUROCs for pre-diction of bacteremia were: NEWS = 0.65, qSOFA = 0.60, SF I = 0.65, mSOFA = 0.71, and SF II = 0.80. Conclu-sions: Scoring systems using only vital signs, NEWS, and SF I showed moderate abilities in predicting bacteremia, whereas qSOFA performed poorly. Scoring systems us-ing both vital signs and laboratory values, mSOFA and especially SF II, showed good abilities in predicting bac-teremia. (c) 2022 The Authors. Published by Elsevier Inc. This is an open access article under the CC BY license( http://creativecommons.org/licenses/by/4.0/ )