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Description

Sunnerhagen et al reported the HANDOC score to evaluate a patient with non-beta-hemolytic Streptococcal bacteremia. This can help to identify a patient who should have echocardiography to exclude infective endocarditis. The authors are from Lund University in Sweden.


Patient selection: positive blood culture with a non-beta hemolytic Streptococcus species

 

Parameters:

(1) heart murmur or valvular disease (H)

(2) aetiology (A)

(3) number of blood cultures containing a streptococcal species (N)

(4) duration of symptoms (D)

(5) only 1 species (O)

(6) community-acquired (C)

 

Parameter

Finding

Points

heart murmur or valvular disease

valvular disease, prosthetic valve or heart murmur

1

 

none of these

0

aetiology

S. bovis

1

 

S. sanguinis

1

 

S. mutans group

1

 

S. anginosus

-1

 

other

0

number of positive blood cultures

1

0

 

>= 2

1

duration of symptoms

<7 days

0

 

>= 7 days

1

number of bacterial species in positive blood cultures

1

1

 

>= 2

0

community-acquired

no

0

 

yes

1

 

total score =

= SUM(points for all 6 parameters)

 

Interpretation:

minimum score: -1

maximum score: 6

A score >= 3 is associated with infective endocarditis and the patient should have echocardiography.

 

Performance:

The sensitivity was 100% and specificity 76%. The negative predictive value is 100%.


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