Greaves et al reported clinical criteria which can help identify patients with possible infective endocarditis who are likely to have positive transthoracic echocardiography. These criteria can help use echocardiography more cost effectively. The authors are from the Royal Prince Alfred Hospital in Sydney, Australia.
Criteria for a positive transthoracic echocardiography:
(1) oscillating mass on (a valve OR supporting structure OR in the path of a regurgitant jet OR on a supporting structure) with no alternative anatomic explanation
(2) abscess related to a prosthetic valve
(3) new partial dehiscence of a prosthetic valve
(4) new valvar regurgitation
Parameters:
(1) vasculitic/embolic phenomenon
(2) central venous access
(3) recent history of injected drug use
(4) presence of a prosthetic valve
(5) positive blood cultures
|
Parameters |
Findings |
Points |
|
vasculitic/embolic phenomenon |
absent |
0 |
|
|
present |
1 |
|
central venous access |
absent |
0 |
|
|
present |
1 |
|
recent history of injected drug use |
absent |
0 |
|
|
present |
1 |
|
prosthetic valve |
absent |
0 |
|
|
present |
1 |
|
blood cultures |
negative |
0 |
|
|
positive |
1 |
total score =
= SUM(points for all 5 parameters)
Interpretation:
• minimum score: 0
• maximum score: 5
• The higher the score the more likely the echocardiography will be positive.
• A patient with none of the clinical criteria does not need to undergo echocardiography.
|
Total Score |
Positive Transthoracic Echocardiography |
|
0 |
0 |
|
1 |
14% |
|
2 |
40% |
|
3 to 5 |
46% |
Specialty: Cardiology
ICD-10: ,
