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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