Clinical- vs. model-based selection of patients suspected of sepsis for direct-from-blood rapid diagnostics in the emergency department: a retrospective study

Abstract

Selecting high-risk patients may improve the cost-effectiveness of rapid diagnostics. Our objective was to assess whether model-based selection or clinical selection is better for selecting high-risk patients with a high rate of bacteremia and/or DNAemia. This study involved a model-based, retrospective selection of patients from a cohort from which clinicians selected high-risk patients for rapid direct-from-blood diagnostic testing. Patients were included if they were suspected of sepsis and had blood cultures ordered at the emergency department. Patients were selected by the model by adding those with the highest probability of bacteremia until the number of high-risk patients selected by clinicians was reached. The primary outcome was bacteremia rate. Secondary outcomes were DNAemia rate, and 30-day mortality. Data were collected for 1395 blood cultures. Following exclusion, 1142 patients were included in the analysis. In each high-risk group, 220/1142 were selected, where 55 were selected both by clinicians and the model. For the remaining 165 in each group, the model selected for a higher bacteremia rate (74/165, 44.8% vs. 45/165, 27.3%, p = 0.001), and a higher 30-day mortality (49/165, 29.7% vs. 19/165, 11.5%, p = 0.00004) than the clinically selected group. The model outperformed clinicians in selecting patients with a high rate of bacteremia. Using such a model for risk stratification may contribute towards closing the gap in cost between rapid and culture-based diagnostics.