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Blood cultures in emergency medical admissions: a key patient cohort.

Content Provider	World Health Organization (WHO)-Global Index Medicus
Author	Chotirmall, Sanjay H. Callaly, Elizabeth Lyons, Judith O'Connell, Brian Kelleher, Mary Byrne, Declan O'Riordan, Deirdre Silke, Bernard
Spatial Coverage	Ireland
Description	Country affiliation: Ireland Author Affiliation: Chotirmall SH ( Departments of aInternal Medicine bMicrobiology, St James's Hospital, Dublin, Ireland.)
Abstract	OBJECTIVES: Blood cultures are performed in the emergency room when sepsis is suspected, and a cohort of patients is thereby identified. The present study investigated the outcomes (mortality and length of hospital stay) in this group following an emergency medical admission. METHODS: Prospective assessment of all emergency medical admissions presenting to the emergency department at St James's Hospital, Dublin, over an 11-year period (2002-2012) was carried out. Outcomes including 30-day in-hospital mortality and length of stay were explored in the context of an admission blood culture. Generalized estimating equations, logistic or zero-truncated Poisson multivariate models were used, with adjustment for confounding variables including illness severity, comorbidity, and chronic disabling disease, to assess the effect of an urgent blood culture on mortality and length of stay. RESULTS: A total of 60 864 episodes were recorded in 35 168 patients admitted over the time period assessed. Patients more likely to undergo blood cultures in the emergency department were male, younger, and had more comorbidity. Univariate and multivariate analyses showed that those who had a blood culture, irrespective of result, had increased mortality and a longer in-hospital stay. This was highest for those with a positive culture, irrespective of the organism isolated. CONCLUSION: A clinical decision to request a blood culture identified a subset of emergency admissions with markedly worse outcomes. This patient cohort warrants close monitoring in the emergency setting.
File Format	HTM / HTML
ISSN	09699546
Issue Number	1
Volume Number	23
e-ISSN	14735695
Journal	European Journal of Emergency Medicine
Language	English
Publisher	Lippincott Williams & Wilkins
Publisher Date	2016-02-01
Publisher Place	Great Britain (UK)
Access Restriction	One Nation One Subscription (ONOS)
Subject Keyword	Discipline Emergency Medicine Bacteremia Blood Blood-borne Pathogens Isolation & Purification Microbiology Emergency Service, Hospital Hospital Mortality Trends Length Of Stay Statistics & Numerical Data Adult Aged Diagnosis Therapy Cohort Studies Female Humans Ireland Logistic Models Male Middle Aged Multivariate Analysis Patient Admission Poisson Distribution Retrospective Studies Risk Assessment Journal Article
Content Type	Text
Resource Type	Article
Subject	Emergency Medicine

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