• Takayuki Komatsu, Erika Takahashi, Kentaro Mishima, Takeo Toyoda, Fumihiro Saitoh, Akari Yasuda, Joe Matsuoka, Manabu Sugita, Joel Branch, Makoto Aoki, Lawrence Tierney, and Kenji Inoue.
• Department of Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, Tokyo, Japan.
• J Hosp Med. 2017 Jul 1; 12 (7): 510-515.

BackgroundPredicting the presence of true bacteremia based on clinical examination is unreliable.ObjectiveWe aimed to construct a simple algorithm for predicting true bacteremia by using food consumption and shaking chills.DesignA prospective multicenter observational study.SettingThree hospital centers in a large Japanese city.ParticipantsIn total, 1,943 hospitalized patients aged 14 to 96 years who underwent blood culture acquisitions between April 2013 and August 2014 were enrolled. Patients with anorexia-inducing conditions were excluded.InterventionsWe assessed the patients' oral food intake based on the meal immediately prior to the blood culture with definition as "normal food consumption" when >80% of a meal was consumed and "poor food consumption" when <80% was consumed. We also concurrently evaluated for a history of shaking chills.MeasurementsWe calculated the statistical characteristics of food consumption and shaking chills for the presence of true bacteremia, and subsequently built the algorithm by using recursive partitioning analysis.ResultsAmong 1,943 patients, 223 cases were true bacteremia. Among patients with normal food consumption, without shaking chills, the incidence of true bacteremia was 2.4% (13/552). Among patients with poor food consumption and shaking chills, the incidence of true bacteremia was 47.7% (51/107). The presence of poor food consumption had a sensitivity of 93.7% (95% confidence interval [CI], 89.4%-97.9%) for true bacteremia, and the absence of poor food consumption (ie, normal food consumption) had a negative likelihood ratio (LR) of 0.18 (95% CI, 0.17-0.19) for excluding true bacteremia, respectively. Conversely, the presence of the shaking chills had a specificity of 95.1% (95% CI, 90.7%-99.4%) and a positive LR of 4.78 (95% CI, 4.56-5.00) for true bacteremia.ConclusionA 2-item screening checklist for food consumption and shaking chills had excellent statistical properties as a brief screening instrument for predicting true bacteremia.© 2017 Society of Hospital Medicine

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