Call for New Infection Diagnosis Criteria in Emergency Department

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Bacterial infections — including lower respiratory, urinary tract, and skin and soft tissue — were either over- or underdiagnosed in ED settings.
Bacterial infections — including lower respiratory, urinary tract, and skin and soft tissue — were either over- or underdiagnosed in ED settings.

HealthDay News — Emergency department physicians need new criteria for diagnosing infection among older adults, according to a study published online recently in the Journal of the American Geriatrics Society.

Jeffrey M. Caterino, MD, MPH, from The Ohio State University in Columbus, and colleagues conducted a prospective study involving individuals aged 65 years and older in the emergency department to compare the accuracy of the Loeb criteria, emergency department physicians' diagnoses, and US Centers for Disease Control and Prevention guidelines for acute bacterial infection.

The researchers identified bacterial infection in 77 of 424 participants (18%) in criterion-standard review. Emergency department physicians diagnosed infection in 17% (71 patients), but 33% and 27% had under- and over-diagnosis, respectively. For infection overall and for each infection type, there was moderate physician agreement with the criterion standard (κ = 0.48-0.59), sensitivity was below 67%, and the negative likelihood ratio (LR[-]) was above 0.30 for all infections. Poor sensitivity, agreement, and LR(-) were seen for the Loeb criteria for lower respiratory (50%, κ = 0.55 and 0.51, respectively) and urinary tract infections (26%, κ = 0.34 and 0.74, respectively); for skin and soft tissue infection, sensitivity was 87% (κ = 0.78; LR[-], 0.14). Moderate agreement was seen for the CDC guidelines, but sensitivity and LR(-) were poor.

"New criteria are needed to aid emergency department physicians in accurately diagnosing infection in older adults," the authors write.

Reference

Caterino JM, Leininger R, Kline DM, et al. Accuracy of current diagnostic criteria for acute bacterial infectionin older adults in the emergency department [published online April 25, 2017]. J Am Geriatr Soc. doi:10.1111/jgs.14912

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