• Dong Hyun Choi, Ki Jeong Hong, Jeong Ho Park, Sang Do Shin, Young Sun Ro, Kyoung Jun Song, Ki Hong Kim, and Sungwan Kim.
• Department of Emergency Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea; Department of Emergency Medicine, Seoul National University Hospital, Seoul, Republic of Korea; Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, Republic of Korea; Department of Biomedical Engineering, Seoul National University College of Medicine, Seoul, Republic of Korea.
• Am J Emerg Med. 2022 Mar 1; 53: 86-93.

IntroductionBacteremia is a common but critical condition with high mortality that requires timely and optimal treatment in the emergency department (ED). The prediction of bacteremia at the ED during triage and disposition stages could support the clinical decisions of ED physicians regarding the appropriate treatment course and safe ED disposition. This study developed and validated machine learning models to predict bacteremia in the emergency department during triage and disposition stages.MethodsThis study enrolled adult patients who visited a single tertiary hospital from 2016 to 2018 and had at least two sets of blood cultures during their ED stay. Demographic information, chief complaint, triage level, vital signs, and laboratory data were used as model predictors. We developed and validated prediction models using 10 variables at the time of ED triage and 42 variables at the time of disposition. The extreme gradient boosting (XGB) model was compared with the random forest and multivariable logistic regression models. We compared model performance by assessing the area under the receiver operating characteristic curve (AUC), test characteristics, and decision curve analysis.ResultsA total of 24,768 patients were included: 16,197 cases were assigned to development, and 8571 cases were assigned to validation. The proportion of bacteremia was 10.9% and 10.4% in the development and validation datasets, respectively. The Triage XGB model (AUC, 0.718; 95% confidence interval (CI), 0.701-0.735) showed acceptable discrimination performance with a sensitivity over 97%. The Disposition XGB model (AUC, 0.853; 95% CI, 0.840-0.866) showed excellent performance and provided the greatest net benefit throughout the range of thresholds probabilities.ConclusionsThe Triage XGB model could be used to identify patients with a low risk of bacteremia immediately after initial ED triage. The Disposition XGB model showed excellent discriminative performance.Copyright © 2021. Published by Elsevier Inc.

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