Utilidad del modelo 5MPB-Toledo para predecir bacteriemia en el paciente anciano / Usefulness of the 5MPB-Toledo model to predict bacteremia in the elderly patient

Resumen Objetivo: Analizar la utilidad del modelo predictivo de bacteriemia (5MPB-Toledo) en los mayores de 65 años atendidos por infección en el servicio de urgencias (SU). Material y Método: Estudio observacional prospectivo y multicéntrico de los hemocultivos (HC) obtenidos en pacientes mayores de 65 años atendidos por infección en 66 SU españoles desde el 1 de diciembre de 2019 hasta el 30 de abril de 2020. Se analizó la capacidad predictiva del modelo con el área bajo la curva (ABC) de la característica operativa del receptor (COR) y se calculó el rendimiento diagnóstico de los puntos de corte (PC) del modelo elegido con los cálculos de la sensibilidad, la especificidad, el valor predictivo positivo y el valor predictivo negativo. Resultados: Se incluyeron 2.401 episodios de HC extraídos. De ellos, se consideró como bacteriemia verdadera a 579 (24,11%) y como HC negativo a 1.822 (75,89%). Entre los negativos, 138 (5,74%) se consideraron contaminados. Se categorizó a los pacientes en bajo (0-2 puntos), moderado (3-5 puntos) y alto (6-8 puntos) riesgo, con una probabilidad de bacteriemia de 1,2%, 18,1% y 80,7%, respectivamente. El ABC-COR del modelo tras remuestreo fue de 0,908 (IC 95%: 0,897-0,924). El rendimiento diagnóstico del modelo, considerando un PC ≥ 5 puntos, obtiene una sensibilidad de 94% (IC 95%:92-96), especificidad de 77% (IC 95%:76-79) y un valor predictivo negativo de 97% (IC 95%:96-98). Conclusión: El modelo 5MPB-Toledo es de utilidad para predecir bacteriemia en los mayores de 65 años atendidos en el SU por un episodio de infección.

Abstract Objective: To analyse a risk score to predict bacteremia (MPB5-Toledo) in the patients aged older 65 years seen in the emergency departments (ED) due to infections. Patients and Methods: Prospective and multicenter observational cohort study of the blood cultures (BC) ordered in 66 Spanish ED for patients aged older 65 years seen from December 1, 2019, to April 30, 2020. The predictive ability of the model was analyzed with the area under the Receiver Operating Characteristic curve (AUC-ROC). The prognostic performance for true bacteremia was calculated with the cut-off values chosen for getting the sensitivity, specificity, positive predictive value and negative predictive value. Results: A total of 2.401 blood samples wered cultured. True cases of bacteremia were confirmed in 579 (24.11%). The remaining 1.822 cultures (75.89%) wered negative. And, 138 (5.74%) were judged to be contaminated. Low risk for bacteremia was indicated by a score of 0 to 2 points, intermediate risk by 3 to 5 points, and high risk by 6 to 8 points. Bacteremia in these 3 risk groups was predicted for 1.2%, 18.1%, and 80.7%, respectively. The model´s area under the receiver ope rating characteristic curve was 0.908 (95% CI, 0.897-0.924). The prognostic performance with a model´s cut-off value of ≥ 5 points achieved 94% (95% CI: 92-96) sensitivity, 77% (95% CI: 76-79) specificity, and negative predictive value of 97% (95% CI: 96-98). Conclusion: The 5MPB-Toledo score is useful for predicting bacteremia in the patients aged older 65 years seen in the emergency departments due to infections.

A bacteraemia risk prediction model: development and validation in an emergency medicine population.

OBJECTIVE: Design a risk model to predict bacteraemia in patients attended in emergency departments (ED) for an episode of infection. METHODS: This was a national, prospective, multicentre, observational cohort study of blood cultures (BC) collected from adult patients (≥ 18 years) attended in 71 Spanish EDs from October 1 2019 to March 31, 2020. Variables with a p value < 0.05 were introduced in the univariate analysis together with those of clinical significance. The final selection of variables for the scoring scale was made by logistic regression with selection by introduction. The results obtained were internally validated by dividing the sample in a derivation and a validation cohort. RESULTS: A total of 4,439 infectious episodes were included. Of these, 899 (20.25%) were considered as true bacteraemia. A predictive model for bacteraemia was defined with seven variables according to the Bacteraemia Prediction Model of the INFURG-SEMES group (MPB-INFURG-SEMES). The model achieved an area under the curve-receiver operating curve of 0.924 (CI 95%:0.914-0.934) in the derivation cohort, and 0.926 (CI 95%: 0.910-0.942) in the validation cohort. Patients were then split into ten risk categories, and had the following rates of risk: 0.2%(0 points), 0.4%(1 point), 0.9%(2 points), 1.8%(3 points), 4.7%(4 points), 19.1% (5 points), 39.1% (6 points), 56.8% (7 points), 71.1% (8 points), 82.7% (9 points) and 90.1% (10 points). Findings were similar in the validation cohort. The cut-off point of five points provided the best precision with a sensitivity of 95.94%, specificity of 76.28%, positive predictive value of 53.63% and negative predictive value of 98.50%. CONCLUSION: The MPB-INFURG-SEMES model may be useful for the stratification of risk of bacteraemia in adult patients with infection in EDs, together with clinical judgement and other variables independent of the process and the patient.

Validación de la Regla Canadiense de la Columna Cervical para el uso de radiografías / Validation of canadian standard of cervical column for its use in radiography

Objetivo. Evaluar de forma prospectiva la Regla Canadiense de la Columna Cervical para determinarsu validez en la clasifi cación de pacientes con sospecha de lesión cervical, así comosu utilidad en la potencial reducción del uso de radiografías.Diseño. Estudio observacional para la validación de pruebas diagnósticas.Emplazamiento. Servicio de urgencias hospitalario.Participantes. 60 pacientes adultos que acudieron al Servicio de Urgencias por un traumatismocerrado de la cabeza o del cuello.Mediciones principales. Solicitud de exploración radiológica y evaluación mediante la ReglaCanadiense de la Columna Cervical. Se incluyó información referente al mecanismo lesional,así como datos epidemiológicos básicos.Resultados. Un mecanismo lesional peligroso apareció en el 45% de los casos. Se diagnosticólesión clínicamente signifi cativa en 3 casos (5%), tratándose de fractura en 2 ocasiones, en lasque se solicitó TAC cervical, y de subluxación en el otro paciente. Los parámetros de validez de la Regla Canadiense de la Columna Cervical en los pacientes incluidos en el estudio fueron: sensibilidad 100%, especifi cidad 7%, valor predictivo positivo 5,26% y valor predictivo negativo 100%. La reducción estimada en la petición de radiografías fue del 7,5%.Conclusiones. La sensibilidad del 100% convierte en segura la regla de decisión y garantizaque todas las lesiones importantes puedan ser correctamente diagnosticadas, sin embargo, la especificidad parece inaceptable y contribuye muy poco a la decisión de no solicitar estudio radiológico

Objective. To make a prospective evaluation of Canadian standard of cervical column in order to determinate if it is useful for the classifi cation of patients with suspected of cervical injury and its value in potential reduction of the use of radiography.Design. Observational study conceived for to evaluate diagnostic techniques.Setting. An emergency hospital department.Subjects. 60 adults patients who visited the emergency department with closed traumatic injuryto the head or neck.Principal measurements. X-Ray evaluation by Canadian standard in cervical column. Havebeen included information about injury mechanism and basic epidemiological dates.Results. In 45 % of cases we have detected a dangerous injury mechanism. Had diagnosed an injury with clinical signifi cance in 3 cases (5 %), 2 of them had fractures (confi rmed by CAT) and subluxation in the other patient. The parameters of Canadian standard for validation of the cervical column of patients included in the study were: sensibility 100 %, specifi city 7 %, positive predictive value 5,26 % and negative predictive value 100 %. The estimated reduction in demand of radiographies was 7.5 %.Conclusions. Sensibility of 100 % makes sure the standard of decision and warranty that all important injuries would be correctly diagnosed, however the specifi city seems unacceptable and contributes very little to the decision of not demand X-Ray study