Palraj et al reported the clinical PREDICT tool for estimating the risk of endocarditis in a patient with Staphylococcus aureus bacteremia. This can help to identify a patient who may benefit from transesophageal echocardiography (TEE). The authors are from the Mayo Clinic in Rochester.
PREDICT = predicting risk of endocarditis clinical tool
Patient selection: Staphylococcus aureus bacteremia
Parameters:
(1) cardiovascular implantable electronic device (CIED)
(2) onset of bacteremia
(3) prolonged bacteremia (>= 72 hours, blood culture on day 3 with results available on day 5)
|
Parameter |
Finding |
Points |
|
CIED |
implantable cardioverter defibrillator (ICD) |
2 |
|
|
permanent pacemaker |
3 |
|
|
Neither |
0 |
|
onset of bacteremia |
Community |
2 |
|
|
healthcare associated |
1 |
|
|
nosocomial |
0 |
|
prolonged bacteremia |
No |
0 |
|
|
Yes |
2 |
score for day 1 =
= (points for CIED) + (points for onset of bacteremia)
score for day 5 =
= SUM(points for all 3 parameters)
Interpretation:
• minimum scores: 0
• maximum day 1 score: 5
• maximum day 5 score: 7
|
Day 1 Score |
Day 5 Score |
Percent Endocarditis |
|
>= 4 |
NA |
41% |
|
< 4 |
>= 2 |
16% |
|
< 4 |
< 2 |
2% |
Performance:
• A score >= 4 on day 1 had a sensitivity of 21% and specificity of 96%.
• A score < 2 on day 5 had a sensitivity of 99% but low specificity.
Specialty: Infectious Diseases, Cardiology
