INTRODUCTIONThe aim of this study was to externally validate the Cham score for the prediction of bacteraemia in emergency department (ED) patients with non-hospital acquired pneumonia.

MATERIALS AND METHODSThis is a secondary analysis of a dataset collected to identify independent predictors of bacteraemia in adult ED patients with non-hospital acquired pneumonia. The primary outcome of interest was the predictive performance (sensitivity, specificity, negative predictive value) of the score with respect to bacteraemia. Secondary outcomes included the performance of the score in patients not known to be intravenous (IV) drug users, the predictive performance of pneumonia severity index (PSI) class IV/V and PSI class IV/V or IV drug use as predictors and the clinical impact of score application on test ordering. Data analysis was by clinical performance and receiver operator characteristic curve analysis.

RESULTSA total of 200 patients were studied; 14 true positive blood cultures (7%, 95% CI, 4% to 11%). The Cham score had a sensitivity of 92.9% (95% CI, 64.2% to 99.6%), specificity of 26.3% (95% CI, 20.3% to 33.4%) and negative predictive value (NPV) of 98% (87.0% to 99.9%). Area under the receiver operating characteristic (ROC) curve was 0.71 (95% CI, 0.56 to 0.86). Using PSI class IV/V or known IV drug use as predictors had sensitivity of 92.9% (95% CI, 64.2% to 99.6%), specificity of 51.1% (95% CI, 43.7% to 58.4%) and NPV of 99% (95% CI, 93.5% to 99.9%).

CONCLUSIONIn retrospective external validation, the Cham score performed better than in derivation with acceptable sensitivity and NPV. Simplified criteria (PSI class IV/V or known IV drug use), as yet not validated, had similar sensitivity and NPV but would avoid blood cultures in a higher proportion of patients.

Aged ; Aged, 80 and over ; Bacteremia ; blood ; diagnosis ; Bacteriological Techniques ; utilization ; Emergency Service, Hospital ; Female ; Hematologic Tests ; utilization ; Humans ; Male ; Middle Aged ; Pneumonia, Bacterial ; blood ; microbiology ; Retrospective Studies

Objective: Recently, a novel score for risk stratification of patients with pulmonary embolism (PE)—the HOPPE score—was derived. We aimed to externally validate the HOPPE score in emergency department-diagnosed PE, using SpO2 as a surrogate for PaO2—the modified HOPPE score. Methods: Retrospective observational study of adult patients with an emergency department diagnosis of PE was performed. Data collected included demographics, co-morbidities, clinical features, electrocardiogram and test results, in-hospital mortality and non-fatal major adverse clinical events (MACE; survived cardiac arrest, cardiogenic shock or thrombolysis administration). The primary outcome of interest was clinical performance of the modified HOPPE score for inhospital mortality and the composite outcome of in-hospital death and MACE. A secondary outcome was comparison of predictive performance between the modified HOPPE score and the simplified Pulmonary Embolism Severity Index score. Results: Two hundred and six patients were studied (median age 61, 55% female). There were no deaths or MACE in patients with a low risk modified HOPPE score of 0 to 6 (0%; 95% confidence interval, 0% to 1.8%). Negative predictive value of a low risk score was 100% (95% confidence interval, 92.2% to 100%) for in-hospital mortality and for the composite of in-hospital mortality or MACE. The modified HOPPE score had similar predictive performance to the simplified Pulmonary Embolism Severity Index score with an area under the curve of 0.88 vs. 0.80 for the composite outcome of in-hospital mortality or MACE (P=0.052). Twenty-eight percent of the patients were classified as low risk and potentially suitable for management as outpatients. Conclusion The modified HOPPE score showed good clinical performance. Prospective validation is warranted.

We aimed to determine head computed tomography (CT) scan rate in the children presenting with non-traumatic headache who visited an Australian community teaching hospital emergency department. This was a planned substudy of an investigation of the epidemiology of headache in children presenting to the emergency department. A total of 225 children were studied; 6 underwent CT scan (CT scan rate, 2.7%; 95% confidence interval, 1.2–5.7). No intracranial pathology was identified. The rate was much lower than previously reported. The optimal CT scan rate for children presenting with headache remains unclear and is worthy of further research.
Child ; Diagnostic Imaging ; Emergencies ; Emergency Service, Hospital ; Epidemiology ; Head ; Headache ; Hospitals, Teaching ; Humans ; Pathology ; Tomography, X-Ray Computed