In this prospective observational cohort, researchers derived and validated a decision rule to predict true bacteremia in 3730 ED patients who had blood cultures drawn (abstract). They determined that patients should get a blood culture if they had at least 1 major or 2 minor criteria (Major criteria were temp>39.5, indwelling vascular catheter, or clinical suspicion of endocarditis; Minor criteria were temp 38.3-39.4, age >65, chills, vomiting, SBP<90, WBC>18, PMN>80%, bands>5%, platelets>150, or creatinine>2). Using these criteria in the validation set, the decision rule had a NPV of 99% (of patients without criteria, <1% actually had bacteremia), indicating its value in identifying those that DO NOT need a blood culture. However, it could not accurately identify those that DO need a blood culture (with a PPV of only 11%, a large number of patients with criteria would not be bacteremic).
by Deepak Asudani, MD, MPH, FHM Whether it is the prompt and expeditious international collaboration to develop an Ebola vaccine, or tardy but promising development of the first anti parasitic malarial vaccine or the fascinating technology utilizing synthetic DNA for vaccine development against MERS, these developments promise to highlight significant strides in vaccine development for […]
Economists describe preferences in two ways: revealed and stated. Say, for example, I asked you to implement a penalty program for your team with the goal of decreasing the number of occasions members did not clean their hands after a patient encounter. Because you know bad hands equal bad outcomes, you’re apt to offer up […]
by Eric Howell, MD, SFHM “Tell me what you know about antibiotics.” That’s the discussion I start with hospitalized patients all the time, right after they ask me to prescribe antibiotics for their simple cough, or other viral-like illness. And, from their perspective, asking for antibiotics makes sense. After all, antibiotics have been the physician’s […]