Blood culture use in the emergency department in patients hospitalized with respiratory symptoms due to a nonpneumonia illness.
Blood culture use in the emergency department in patients hospitalized with respiratory symptoms due to a nonpneumonia illness.
复制标题
血培养在急诊室用于因非肺炎疾病而出现呼吸道症状的患者。
DOI：
10.1002/jhm.2205
复制
发表时间：
2014
影响因子：
2.6
通讯作者：
Steinman,MichaelA
中科院分区：
文献类型：
--
作者：
Makam,AnilN;Auerbach,AndrewD;Steinman,MichaelA
指南和性能指标建议在选定的社区获得性肺炎（CAP）住院患者中进行血培养。由于固有的诊断不确定性，这些建议可能会对其他类似肺炎的情况产生溢出效应。方法使用2002年至2010年全国医院门诊医疗调查的数据，美国急诊科（艾德）访问的全国代表性样本，我们使用线性回归分析了因非肺炎疾病引起的呼吸道症状住院患者的培养趋势。这些就诊包括心力衰竭（16%）、慢性阻塞性肺病（13%）和胸痛（12%）。这些访视期间在艾德采集的培养物比例从2002年的10%（95%置信区间[CI]：7%-14%）增加至2010年的20%（95% CI：16%-26%）（趋势P< 0.001）。这代表了一个平行的增加与CAP住院的患者相比（P= 0.12的趋势差异）。CONCLUSIONSSThe增加收集文化的艾德在住院的呼吸道症状，由于非肺炎疾病的患者表明一个重要的潜在的意外后果血培养CAP的建议。需要更多地关注血培养的明智使用，以减少伤害和成本。医院医学杂志2014;9：521-524。© 2014医院医学学会
BACKGROUNDGuidelines and performance measures recommend obtaining blood cultures in selected patients hospitalized with community‐acquired pneumonia (CAP). Due to inherent diagnostic uncertainty, there may be spillover effects of these recommendations on other conditions that resemble pneumonia.METHODSUsing data from the 2002 to 2010 National Hospital Ambulatory Medical Care Survey, a nationally representative sample of emergency department (ED) visits in the United States, we analyzed trends in obtaining cultures in patients hospitalized with respiratory symptoms due to a nonpneumonia illness using linear regression.RESULTSThe most common primary admission diagnoses for these visits included heart failure (16%), chronic obstructive pulmonary disease (13%), and chest pain (12%). The proportion of cultures collected in the ED during these visits increased from 10% (95% confidence interval [CI]: 7%‐14%) in 2002 to 20% (95% CI: 16%‐26%) in 2010 (P< 0.001 for the trend). This represented a parallel increase compared to patients hospitalized with CAP (P= 0.12 for the difference in trends).CONCLUSIONSThe increase in collecting cultures in the ED in patients hospitalized with respiratory symptoms due to a nonpneumonia illness suggests an important potential unintended consequence of blood culture recommendations for CAP. More attention to the judicious use of blood cultures to reduce harm and costs is needed.Journal of Hospital Medicine2014;9:521–524. © 2014 Society of Hospital Medicine