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Diagnostic Algorithm of Aly et al for Diagnosing Infective Endocarditis in a Pediatric Patient or Young Adult

Purpose: To identify a pediatric patient or young adult who should have transthoracic echocardiography to exclude infective endocarditis (IE).

Description

Aly et al developed an algorithm for diagnosing infective endocarditis (IE). The goal is to increase the pretest probability for infective endocarditis before ordering transthoracic echocardiography.  The authors are from the Children's Hospital of Michigan and Wayne State University.


Patient population: mixed race age range 0.5 to 29.3 years (median 8.5 years)

 

Parameters:

(1) malaise (ill-appearing)

(2) number of positive blood cultures with the same organism (and a potential pathogen)

(3) indwelling vascular catheter

(4) new or changing heart murmur

 

Malaise

Positive Blood Cultures

Indwelling Catheter

Heart Murmur

Percent IE

No

0 or 1

NA

NA

0%

No

>= 2

No

NA

50%

No

>= 2

Yes

NA

0%

Yes

0 or 1

NA

NA

43%

Yes

>= 2

NA

No

83%

Yes

>= 2

NA

Yes

100%

 

The 4 patterns with percent infective endocarditis >= 43% were indications for transthoracic endocarditis.

 

The algorithm could be simplified to doing echocardiography if:

(1) the patient has malaise OR

(2) the patient has >=2 positive blood cultures and does not have an indwelling catheter

 

Clinical findings associated with infective endocarditis and positive transthoracic echocardiography:

(1) malaise

(2) congestive heart failure

(3) new or changing heart murmur


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Specialty

Objective

ICD-10