Shapiro et al developed criteria for which patients should have a blood culture drawn. This can help to reduce unnecessary testing. The authors are from Beth Israel Deaconess Medical Center, Brigham and Women's Hospital and Harvard Medical School in Boston.
Parameters:
(1) suspicion of endocarditis
(2) temperature
(3) indwelling vascular catheter
(4) age in years
(5) chills
(6) vomiting
(7) hypotension (systolic blood pressure < 90 mm Hg)
(8) white blood cell count
(9) percent bands in the peripheral blood smear
(10) platelet count
(11) serum creatinine
|
Parameter |
Finding |
Points |
|
suspect endocarditis |
no |
0 |
|
|
yes |
3 |
|
temperature |
> 39.4°C |
3 |
|
|
38.3 to 39.3°C |
1 |
|
|
< 38.3°C |
0 |
|
indwelling vascular catheter |
absent |
0 |
|
|
present |
2 |
|
age in years |
<= 65 years of age |
0 |
|
|
> 65 years of age |
1 |
|
chills |
absent |
0 |
|
|
present |
1 |
|
vomiting |
absent |
0 |
|
|
present |
1 |
|
systolic blood pressure |
>= 90 mm Hg |
0 |
|
|
< 90 mm Hg |
1 |
|
white blood cell count |
<= 18,000 per µL |
0 |
|
|
> 18,000 per µL |
1 |
|
percent bands |
0 to 5% |
0 |
|
|
>= 6% |
1 |
|
platelet count |
< 150,000 per µL |
1 |
|
|
>= 150,000 per µL |
0 |
|
serum creatinine |
<= 2.0 mg/dL |
0 |
|
|
> 2.0 mg/dL |
1 |
where:
• The 3 items with points >= 2 are called major criteria while the others are considered minor. The presence of 1 major or 2 minor is sufficient to justify a blood culture.
total score =
= SUM(points for all 11 parameters)
Interpretation:
• minimum score: 0
• maximum score: 16
• A patient with a score >= 2 should have a blood culture drawn.
Performance:
• The sensitivity is high (97%) while the specificity is low (29%).
• The test was able to reduce the number of blood cultures performed by 27%.
Purpose: To determine if a patient in the Emergency Department should have a blood culture drawn using the decision rule of Shapiro et al.
Specialty: Infectious Diseases
Objective: laboratory tests, other testing
ICD-10: ,
