Observational studyJournal of the American Geriatrics Society2019
Nonspecific Symptoms Lack Diagnostic Accuracy for Infection in Older Patients in the Emergency Department.
Observational study in Journal of the American Geriatrics Society, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 38 papers, 1 of them a synthesis that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
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.
The trial behind it
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.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
38 citing papers in PubMed, 1 synthesis or guideline pooled it, 55 citations in OpenAlex.
- Delirium detection in the emergency department: A diagnostic accuracy meta-analysis of history, physical examination, laboratory tests, and screening instruments.Academic emergency medicine : official journal of the Society for Academic Emergency Medicine · 2024Pooled it
- Diagnosis of urinary tract infection in the emergency department - a real infection or an alarming indication for comprehensive geriatric assessment? A retrospective follow-up study.The Journal of frailty & aging · 2026Article
- 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
- Integration of the circulating miRNome and clinical information to predict 90-day mortality in elderly COVID-19 subphenotypes.iScience · 2026Article
- A retrospective analysis of emergency department cultures in a tertiary care center.BMC infectious diseases · 2026Article
- Clinical Features, CT Imaging Decisions and Yield by Age in Adults With Abdominal Pain in the Emergency Department.Academic emergency medicine : official journal of the Society for Academic Emergency Medicine · 2026Article
- Early discontinuation of antibiotic therapy initiated in the emergency department in older patients: a retrospective study.BMC geriatrics · 2026Observational
- AI-based clinical prediction model for early infectious disease classification in the emergency department.Frontiers in artificial intelligence · 2026Article
- Home Time Following Emergency Department Visits Among People With Dementia.JAMA network open · 2025Article
- Article
- 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
- Clinical features and risk factors of older adults with bloodstream infection.BMC geriatrics · 2025Article
- Antimicrobial Peptides (AMPs) Are Not Increased in Asymptomatic Bacteriuria in Healthy Older Adult Patients.Journal of the American Geriatrics Society · 2025Article
- Antibiotic Overprescription for "Urinary Tract Infections" Is Associated With Poor Diagnostic Stewardship and Low Adherence to Guidelines.Neurourology and urodynamics · 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
- Review
- The clinical usefulness of guideline-based strategies with and without the role of nonspecific symptoms to predict urinary tract infections in nursing homes: a decision curve analysis.Antimicrobial stewardship & healthcare epidemiology : ASHE · 2024Article
- Diagnosis of urinary tract infections in the hospitalized older adult population in Alberta.PloS one · 2024Article
- 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
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
9 authors at 5 institutions in 1 country.
Funding
Abstract
objectivesTo determine if nonspecific symptoms and fever affect the posttest probability of acute bacterial infection in older patients in the emergency department (ED).
designPreplanned, secondary analysis of a prospective observational study.
settingTertiary care, academic ED.
participantsA total of 424 patients in the ED, 65 years or older, including all chief complaints. MEASUREMENTS: We identified presence of altered mental status, malaise/lethargy, and fever, as reported by the patient, as documented in the chart, or both. Bacterial infection was adjudicated by agreement among two or more of three expert reviewers. Odds ratios were calculated using univariable logistic regression. Positive and negative likelihood ratios (PLR and NLR, respectively) were used to determine each symptom's effect on posttest probability of infection.
resultsOf 424 subjects, 77 (18%) had bacterial infection. Accounting for different reporting methods, presence of altered mental status (PLR range, 1.40-2.53) or malaise/lethargy (PLR range, 1.25-1.34) only slightly increased posttest probability of infection. Their absence did not assist with ruling out infection (NLR, greater than 0.50 for both). Fever of 38°C or higher either before or during the ED visit had moderate to large increases in probability of infection (PLR, 5.15-18.10), with initial fever in the ED perfectly predictive, but absence of fever did not rule out infection (NLR, 0.79-0.92). Results were similar when analyzing lower respiratory, gastrointestinal, and urinary tract infections (UTIs) individually. Of older adults diagnosed as having UTIs, 47% did not complain of UTI symptoms.
conclusionsThe presence of either altered mental status or malaise/lethargy does not substantially increase the probability of bacterial infection in older adults in the ED and should not be used alone to indicate infection in this population. Fever of 38°C or higher is associated with increased probability of infection. J Am Geriatr Soc 67:484-492, 2019.
Indexed as
Identifiers
What OpenQuestion holds
Registered trials
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.