Evidence map›Paper›PMID 32291611›Full record

ArticleInfection2020

The Shapiro-Procalcitonin algorithm (SPA) as a decision tool for blood culture sampling: validation in a prospective cohort study.

Géraldine Wyss, Silvia Berger, Sebastian Haubitz, Hans Fankhauser, Ulrich Buergi, Beat Mueller, Philipp Schuetz, Christoph A Fux, Anna Conen

Abstract readValidation Study
PubMed Publisher
In one paragraph

Article in Infection, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 8 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
8citing papers in PubMed, 1 pooled it
–field-weighted citation impact
1 · What the graph read from 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.

2 · The registry

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.

3 · Its place in the literature

Who cites it

8 citing papers in PubMed, 1 synthesis or guideline pooled it.

  1. [Diagnostic accuracy of procalcitonin for bacteremia in the emergency department: a systematic review].Revista espanola de quimioterapia : publicacion oficial de la Sociedad Espanola de Quimioterapia · 2024
    Pooled it
  2. Article
  3. Article
  4. Article
  5. Article
  6. Article
  7. Article
  8. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

9 authors.

Géraldine WyssMedical University Clinic, Kantonsspital Aarau, Aarau, Switzerland.
Silvia BergerMedical University Clinic, Kantonsspital Aarau, Aarau, Switzerland.
Sebastian HaubitzMedical University Clinic, Kantonsspital Aarau, Aarau, Switzerland.
Hans FankhauserDepartment of Clinical Microbiology, Institute of Laboratory Medicine, Kantonsspital Aarau, Aarau, Switzerland.
Ulrich BuergiDepartment of Emergency Medicine, Kantonsspital Aarau, Aarau, Switzerland.
Beat MuellerMedical University Clinic, Kantonsspital Aarau, Aarau, Switzerland.
Philipp SchuetzMedical University Clinic, Kantonsspital Aarau, Aarau, Switzerland.
Christoph A FuxMedical University Clinic, Kantonsspital Aarau, Aarau, Switzerland.
Anna ConenDepartment of Infectious Diseases and Hospital Hygiene, Kantonsspital Aarau, Aarau, Switzerland. anna.conen@ksa.ch.ORCID http://orcid.org/0000-0002-5216-4109

Funding

Research Fund Kantonsspital Aarau 068
6 · The paper itself

Abstract

purposeBlood cultures (BC) are the gold standard for bacteremia detection despite a relatively low diagnostic yield and high costs. A retrospective study reported high predictive values for BC positivity when combining the clinical Shapiro score with procalcitonin (PCT).

methodsSingle-center, prospective cohort study between 01/2016 and 02/2017 to validate SPA algorithm, including a modified Shapiro score ≥ 3 points (S) PLUS admission PCT > 0.25 µg/l (P), or presence of overruling safety criteria (A) in patients with systemic inflammatory response syndrome. The diagnostic yield of SPA compared to non-standardized clinical judgment in predicting BC positivity was calculated and results presented as odds ratios (OR) with 95% confidence intervals.

resultsOf 1438 patients with BC sampling, 215 (15%) had positive BC which increased to 31% (173/555) in patients fulfilling SP criteria (OR for BC positivity 9.07 [6.34-12.97]). When adding 194 patients with overruling safety criteria (i.e., SPA), OR increased to 11.12 (6.99-17.69), although BC positivity slightly decreased to 26%. With an area under the receiver operating curve of 0.742, SPA indicated better diagnostic performance than its individual components. Positive BC in 689 patients not fulfilling SPA (sampling according to non-standardized clinical judgment) were rare (3%; OR for BC positivity 0.09 [0.06-0.14]). Eight out of 21 missed pathogens were still identified by sampling the primary infection focus.

conclusionsThis study validates the high predictive value of SPA for bacteremia, increasing true BC positivity from 15 to 26%. Restricting BC sampling to SPA would have reduced BC sampling by 48%, while still detecting 194/215 organisms (90%), which makes SPA a valuable diagnostic stewardship tool.

Indexed as

AlgorithmsDecision Support TechniquesSampling StudiesAgedAged, 80 and overBacteremiaBlood CultureDecision MakingFemaleHumansMaleMiddle AgedProcalcitoninProspective StudiesSwitzerlandProcalcitoninBlood cultureDiagnostic stewardshipProcalcitoninShapiro

Identifiers

PMID32291611

What OpenQuestion holds

Textmetadata
Read underepoch 390

Registered trials

None linked

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.