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Overview :
An index can be used to identify those adults with acute,
unexplained fever who have bacteremia or an occult bacterial infection.
Patients studied:
• 926 patients 16 years of age or older during 11 months from
1982 to 1983
• oral or rectal temperature >= 37.9°C (100.2°F) for less
than 3 weeks duration
• examined at Yale-New Haven Hospital Emergency Department by
internists
Parameters found associated with bacteremia or occult
bacterial infection:
(1) age
(2) presence of diabetes mellitus
(3) erythrocyte sedimentation rate (Wintrobe)
(4) white blood cell count
(5) neutrophil band count
|
Parameter |
Finding |
Points |
|
age |
>= 50 years of age |
1 |
|
|
< 50 years of age |
0 |
|
diabetes mellitus |
present |
1 |
|
|
absent |
0 |
|
erythrocyte sedimentation rate |
>= 30 mm/h |
1 |
|
|
< 30 mm/h |
0 |
|
white blood cell count |
>= 15,000 per µL |
1 |
|
|
< 15,000 per µL |
0 |
|
neutrophil band count |
>= 1,500 per µL |
1 |
|
|
< 1,500 per µL |
0 |
index =
= SUM(points for parameters present)
Interpretation:
• minimum score: 0
• maximum score: 5
|
Index |
% with
Bacteremia |
% with Bacteremia or Focal
Infection |
|
0 |
0% |
5% |
|
1 |
7% |
33% |
|
2 |
16% |
39% |
|
3 - 5 |
39% |
55% |
Additional insights during study:
• Appearing
seriously ill can be seen in patients without bacterial infection.
• Some
patients with bacteremia may not appear sufficiently ill to warrant
hospitalization.
• An
initial temperature >= 39.4°C (103°F) was not predictive of occult bacterial
infection.
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