Affiliations

Advocate Aurora Research Institute

Advocate Aurora Health Emergency Department

Aurora BayCare Medical Center Emergency Medicine, BayCare Clinic

Presentation Notes

Poster presented at: Aurora Scientific Day; May 20, 2020; virtual webinar hosted in Milwaukee, WI.

Abstract

Background: Procalcitonin (PCT) is used as a biomarker for the diagnosis of serious bacterial infections (SBI). To date, studies have not compared PCT to clinical judgment and it remains unclear whether PCT adds to the physician’s clinical judgment when diagnosing SBI.

Purpose: To evaluate the diagnostic usefulness of PCT in comparison to blood culture results and the physician’s clinical judgment in patients presenting to the emergency department with signs of SBI.

Methods: A prospective cohort study was conducted with 400 patients suspected of having an SBI who presented to the emergency department at 2 community hospitals in Wisconsin from 2016 to 2018. PCT was performed on all patients in addition to the standard of care (SOC) for suspected SBI. PCT results were not available to the physicians throughout the duration of the study. Physicians completed a brief survey that asked if they thought the patient was septic upon ordering SOC labs and again after they reviewed the SOC lab results. Data were collected to determine if patients were diagnosed with an SBI during their stay. Multivariate logistic regression was used to examine factors associated with an SBI diagnosis.

Results: Among the patients, 186 (46.5%) were diagnosed with an SBI during their hospital stay. High serum levels of PCT (≥0.25 ng/ mL) were an independently significant predictor for an SBI diagnosis in patients with signs of infection (odds ratio [OR]: 1.96, 95% CI: 1.13–3.39; P=0.016). In addition, patients suspected of having an SBI are 2.62 times more likely to be diagnosed with an SBI when the blood culture result is positive (OR: 2.62, 95% CI: 1.19–5.77; P=0.017) and 7.13 times more likely to be diagnosed with an SBI when the physician believes the patient is septic after reviewing the SOC lab results (OR: 7.13, 95% CI: 3.64–13.97; P<0.001). There was no association between the physician’s clinical judgment before reviewing the SOC lab results and SBI diagnosis (OR: 1.74, 95% CI: 0.88–3.45; P=0.111). None of the other factors, including lactic acid, were found to be significant predictors for an SBI diagnosis.

Conclusion: Procalcitonin, blood culture results, and clinician judgment after reviewing standard-of-care labs provide important diagnostic value when diagnosing serious bacterial infections. Clinician judgment before reviewing SOC lab results was not associated with an SBI diagnosis; thus, SOC labs do have added value in aiding physician assessment of potential SBI. This study offers a unique perspective as, to date, no other studies have compared PCT results to clinical judgment.

Document Type

Article

PubMed ID

33163557

DOI

10.17294/2330-0698.1818

Link to Full Text

 

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