Observational studyJournal of the American Geriatrics Society2017
Accuracy of Current Diagnostic Criteria for Acute Bacterial Infection in Older Adults in the Emergency Department.
Observational study in Journal of the American Geriatrics Society, 2017. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 27 papers, 1 of them a synthesis that pooled it.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
27 citing papers in PubMed, 1 synthesis or guideline pooled it, 44 citations in OpenAlex.
- Interventions to improve appropriate antibiotic prescribing in long-term care facilities: a systematic review.BMC geriatrics · 2020Pooled it
- Risk factors associated with apyrexia during bacteraemia: a prospective multicenter cohort study.European journal of clinical microbiology & infectious diseases : official publication of the European Society of Clinical Microbiology · 2026Article
- Article
- Assessment of Inter-rater Variability in the Diagnosis of Urinary Tract Infections in the Emergency Department.The western journal of emergency medicine · 2026Article
- The overuse of antimicrobials during the COVID-19 pandemic: data from 25 general hospitals in Shanxi, China.BMC infectious diseases · 2025Article
- A Host-Protein Test for Differentiating Bacterial From Viral Infection: Diagnostic Accuracy in Elderly Patients.Journal of the American College of Emergency Physicians open · 2025Article
- Risk factors of respiratory tract infection in patients after surgery under general anesthesia and nursing countermeasures.African health sciences · 2025Article
- Pneumonia Diagnosis Agreement Between Treating Emergency Physicians and Adjudicators in Older Adult Emergency Department Patients.Journal of the American College of Emergency Physicians open · 2025Article
- Antimicrobial Peptides (AMPs) Are Not Increased in Asymptomatic Bacteriuria in Healthy Older Adult Patients.Journal of the American Geriatrics Society · 2025Article
- Epidemiology, risk factors, and antimicrobial resistance of nosocomial infections in the intensive care unit trauma patients: A cross-sectional study.Journal of research in medical sciences : the official journal of Isfahan University of Medical Sciences · 2025Article
- Article
- Clinical performance of existing diagnostic criteria for pneumonia in older emergency patients: A prospective cohort study.Journal of the American Geriatrics Society · 2024Observational
- Emergency department patient and physician survey accuracy compared to chart abstraction in patients with acute respiratory illness.Academic emergency medicine : official journal of the Society for Academic Emergency Medicine · 2023Article
- Implementing a multidisciplinary rapid geriatric observation unit for non-critical older patients referred to hospital: observational study on real-world data.Aging clinical and experimental research · 2022Observational
- Antibiotic Use and Bacterial Infection among Inpatients in the First Wave of COVID-19: a Retrospective Cohort Study of 64,691 Patients.Antimicrobial agents and chemotherapy · 2021Article
- Improved diagnostics of infectious diseases in emergency departments: a protocol of a multifaceted multicentre diagnostic study.BMJ open · 2021Article
- Article
- Improving early detection of infection in nursing home residents in South Africa.International journal of Africa nursing sciences · 2021Article
- Asymptomatic Bacteriuria versus Symptom Underreporting in Older Emergency Department Patients with Suspected Urinary Tract Infection.Journal of the American Geriatrics Society · 2020Observational
- Conceptualizations of clinical decision-making: a scoping review in geriatric emergency medicine.BMC emergency medicine · 2020Article
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Authors and funding
8 authors at 4 institutions in 1 country.
Funding
Abstract
objectivesTo compare the accuracy of the Loeb criteria, emergency department (ED) physicians' diagnoses, and Centers for Disease Control and Prevention (CDC) guidelines for acute bacterial infection in older adults with a criterion standard expert review.
designProspective, observational study.
settingUrban, tertiary-care ED.
participantsIndividuals aged 65 and older in the ED, excluding those who were incarcerated, underwent a trauma, did not speak English, or were unable to consent. MEASUREMENTS: Two physician experts identified bacterial infections using clinical judgement, participant surveys, and medical records; a third adjudicated in cases of disagreement. Agreement and test characteristics were measured for ED physician diagnosis, Loeb criteria, and CDC surveillance guidelines.
resultsCriterion-standard review identified bacterial infection in 77 of 424 participants (18%) (18 (4.2%) lower respiratory, 19 (4.5%) urinary tract (UTI), 22 (5.2%) gastrointestinal, 15 (3.5%) skin and soft tissue). ED physicians diagnosed infection in 71 (17%), but there were 33 with under- and 27 with overdiagnosis. Physician agreement with the criterion standard was moderate for infection overall and each infection type (κ = 0.48-0.59), but sensitivity was low (<67%), and the negative likelihood ratio (LR(-)) was greater than 0.30 for all infections. The Loeb criteria had poor sensitivity, agreement, and LR(-) for lower respiratory (50%, κ = 0.55; 0.51) and urinary tract infection (26%, κ = 0.34; 0.74), but 87% sensitivity (κ = 0.78; LR(-) 0.14) for skin and soft tissue infections. CDC guidelines had moderate agreement but poor sensitivity and LR(-).
conclusionEmergency physicians often under- and overdiagnose infections in older adults. The Loeb criteria are useful only for diagnosing skin and soft tissue infections. CDC guidelines are inadequate in the ED. New criteria are needed to aid ED physicians in accurately diagnosing infection in older adults.
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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.