• Am J Emerg Med · May 2018

    Impact of bacteremia prediction rule in CAP: Before and after study.

    • Byunghyun Kim, Kyuseok Kim, Jieun Lee, Joonghee Kim, Yoo Hwan Jo, Jae Hyuk Lee, and Ji Eun Hwang.
    • Department of Emergency Medicine, Seoul National University Bundang Hospital, 166 Gumi-ro, Bundang-gu, Seongnam-si, Gyeonggi-do 463-707, Republic of Korea.
    • Am J Emerg Med. 2018 May 1; 36 (5): 758762758-762.

    ObjectiveIn cases of community acquired pneumonia (CAP), it has been known that blood cultures have low yields and rarely affect clinical outcomes. Despite many studies predicting the likelihood of bacteremia in CAP patients, those results have been rarely implemented in clinical practice, and use of blood culture in CAP is still increasing. This study evaluated impact of implementing a previously derived and validated bacteremia prediction rule.MethodsIn this registry-based before and after study, we used piecewise regression analysis to compare the blood culture rate before and after implementation of the prediction rule. We also compared 30-day mortality, emergency department (ED) length of stay, time-interval to initial antibiotics after ED arrival, and any changes to the antibiotics regimen as results of the blood cultures. In subgroup analysis, we compared two groups (with or without the use of the prediction rule) after implementation period, using propensity score matching.ResultsFollowing the implementation, the blood culture rate declined from 85.5% to 78.1% (P=0.003) without significant changes in 30-day mortality and antibiotics regimen. The interval to initial antibiotics (231min vs. 221min, P=0.362) and length of stay (1019min vs. 954min, P=0.354) were not significantly changed. In subgroup analysis, the group that use the prediction rule showed 25min faster antibiotics initiation (P=0.002) and 48min shorter length of stay (P=0.007) than the group that did not use the rule.ConclusionImplementation of the bacteremia prediction rule in CAP patients reduced the blood culture rate without affecting the 30-day mortality and antibiotics regimen.Copyright © 2017 Elsevier Inc. All rights reserved.

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