Accuracy of Current Diagnostic Criteria for Acute Bacterial Infection in Older Adults in the Emergency Department.
Accuracy of Current Diagnostic Criteria for Acute Bacterial Infection in Older Adults in the Emergency Department.
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DOI：
10.1111/jgs.14912
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发表时间：
2017-08
影响因子：
6.3
通讯作者：
Stevenson KB
中科院分区：
文献类型：
--
作者：
Caterino JM;Leininger R;Kline DM;Southerland LT;Khaliqdina S;Baugh CW;Pallin DJ;Stevenson KB
为了评估急诊科(ED)医生诊断老年人急性细菌感染的准确性，将Loeb标准和CDC指南与黄金标准专家评审进行比较。前瞻性、观察性研究。城市，三级保健教育。≥年龄65岁的ED患者，不包括那些被监禁、创伤、非英语语言或无法同意的患者。两名内科专家通过临床判断、患者调查和医疗记录确定了细菌感染；第三名专家在存在分歧的情况下做出裁决。对ED医生诊断、Loeb标准和疾病预防控制中心监测指南的一致性和测试特征进行了测量。金标准回顾确定77/424名患者中有细菌感染(18%)：18例(4.2%)下呼吸道、19例(4.5%)尿路(UTI)、22例(5.2%)胃肠道和15例(3.5%)皮肤/软组织。急诊科医生诊断出71例(17%)感染，但有33例诊断不足，27例过度诊断。医生对感染总体和每种感染类型的一致性为中等(kappa[k]0.48-0.59)，但敏感性较低(<；67%)，对于所有感染，负似然比(LR[−])>；0.30。LOEB标准对下呼吸道感染(50%；k=0.55；0.51)和尿路感染(26%；k=0.34；0.74)的敏感性、符合性和LR(−)较差，但对皮肤/软组织感染的敏感性为87%(k=0.78；LR[−]0.14)。美国疾病控制与预防中心的指南具有中等的一致性，但敏感度和LR(−)较差。在老年人中，急诊医生经常低估和过度诊断感染。Loeb标准仅对诊断皮肤/软组织感染有用。美国疾病控制与预防中心的指导方针在教育署是不充分的。需要新的标准来帮助急诊医生准确诊断老年人的感染。
To evaluate the accuracy of emergency department (ED) physicians’, the Loeb criteria, and CDC guideline diagnoses of acute bacterial infection in older adults compared to a gold standard expert review. Prospective, observational study. Urban, tertiary-care ED. ED patients aged ≥65 years, excluding those incarcerated, traumas, non-English speaking, or unable to consent. Two physician experts identified bacterial infections using clinical judgement, patient surveys, and medical records; a third adjudicated in cases of disagreement. Agreement and test characteristics were measured for ED physician diagnosis, Loeb criteria, and CDC surveillance guidelines. Gold-standard review identified bacterial infection in 77/424 patients (18%): 18(4.2%) lower respiratory, 19(4.5%) urinary tract (UTI), 22(5.2%) gastrointestinal, and 15(3.5%) skin/soft tissue. ED physicians diagnosed infection in 71 (17%), but there were 33 with under- and 27 with over-diagnosis. Physician agreement with the gold standard was moderate for infection overall and each infection type (kappa [k] 0.48–0.59), but sensitivity was low (<67%), and negative likelihood ratio (LR[−]) >0.30 for all infections. Loeb criteria had poor sensitivity, agreement, and LR(−) for lower respiratory (50%; k=0.55; 0.51) and UTI (26%; k=0.34; 0.74), but 87% sensitivity (k=0.78; LR[−] 0.14) for skin/soft tissue infection. CDC guidelines had moderate agreement, but poor sensitivity and LR(−). Infections are often under- and over-diagnosed by emergency physicians in older adults. The Loeb criteria are useful only for diagnosing skin/soft tissue infections. CDC guidelines are inadequate in the ED. New criteria are needed to aid ED physicians in accurately diagnosing infection in older adults.
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作者：
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通讯作者：
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DOI：
10.1111/j.1532-5415.2007.01217.x
发表时间：
2007-07-01
影响因子：
6.3
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