This Article  • References  • Full text PDF  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Citing articles on Web of Science (62)  • Contact me when this article is cited  Related Content  • Similar articles in this journal  Social Bookmarking   What's this?

A Clinical Model for Diagnosis

Leonard Leibovici, MD; Shai Greenshtain, MD; Ohad Cohen, MD; Felix Mor, MD; Arjeh J Wysenbeek, MD

Arch Intern Med. 1991;151(9):1801-1806.

Abstract
Among 244 patients aged 18 to 98 years who were consecutively hospitalized in a department of internal medicine because of a febrile disease, 52 (21%) were bacteremic. On a logistic regression analysis, five variables known within 24 hours of admission were found to be associated both significantly and independently with bacteremia: low serum albumin level, low premorbid performance status, chills, renal failure, and an assumptive diagnosis of urinary tract infection on admission. The logistic model was used to divide patients into three groups. In group 1, the percentage of bacteremic patients was 5%, in group 2, 40%, and in group 3, 83%. The percentage of deaths in the three groups was 0%, 23%, and 50%, respectively. The model was validated in a second group of 257 patients. The percentage of bacteremia was 1% in group 1, 23% in group 2, and 65% in group 3. The death rate in the three groups was 3%, 4%, and 35%, respectively. The accuracy of the attending physician in diagnosing bacteremia within 24 hours of hospitalization was compared with that of the model. Use of the model could have improved the diagnostic accuracy in 5% of the patients in group 1 and in 18% of patients in group 3.

(Arch Intern Med. 1991;151:1801-1806)

Author Affiliations
From the Department of Medicine B, Beilinson Medical Center, Petah Tiqva, Israel, and the Sackler Faculty of Medicine, University of Tel Aviv, Ramat Aviv, Israel.

Footnotes
Accepted for publication February 18, 1991.

Reprint requests to Department of Medicine B, Beilinson Medical Center, 49 100 Petah Tiqva, Israel (Dr Leibovici).

CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati    Twitter     What's this?

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Updated Review of Blood Culture Contamination
Hall and Lyman
Clin. Microbiol. Rev. 2006;19:788-802.
ABSTRACT | FULL TEXT  

A simple prediction algorithm for bacteraemia in patients with acute febrile illness
Tokuda et al.
QJM 2005;98:813-820.
ABSTRACT | FULL TEXT  

Febrile adults presenting to the emergency department: outcomes and markers of serious illness
Knott et al.
Emerg. Med. J. 2004;21:170-174.
ABSTRACT | FULL TEXT  

Blood Cultures in the Critical Care Unit: Improving Utilization and Yield
Shafazand and Weinacker
Chest 2002;122:1727-1736.
ABSTRACT | FULL TEXT  

The Clinical Host Response to Microbial Infection in Medical Patients With Fever
Bossink et al.
Chest 1999;116:380-390.
ABSTRACT | FULL TEXT  

Long-term Survival Following Bacteremia or Fungemia
Leibovici et al.
JAMA 1995;274:807-812.
ABSTRACT  

Clinical Issues of Blood Cultures
Chandrasekar and Brown
Arch Intern Med 1994;154:841-849.
ABSTRACT  

Acute Fevers of Unknown Origin: A Plea for Restraint
DiNubile
Arch Intern Med 1993;153:2525-2526.
ABSTRACT  

Toward Improved Empiric Management of Moderate to Severe Urinary Tract Infections
Leibovici et al.
Arch Intern Med 1992;152:2481-2486.
ABSTRACT