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External validation of the HANDOC score - high sensitivity to identify patients with non-beta-haemolytic

Torgny Sunnerhagen1, Malene Højgaard Andersen2, Niels Eske Bruun3,4,5

  • 1Division for Infection Medicine, Department of Clinical Sciences, Medical Faculty, Lund University, Lund, Sweden.

Infectious Diseases (London, England)
|October 18, 2019
PubMed

Insights

The HANDOC score accurately identifies patients with non-beta-haemolytic streptococci bacteremia at low risk for infective endocarditis (IE). This validation confirms its 100% sensitivity, supporting its use to potentially omit echocardiography in low-risk cases.

Area of Science:

  • Infectious Diseases
  • Cardiology
  • Clinical Microbiology

Background:

  • Non-beta-haemolytic streptococci (NBHS) bacteremia poses diagnostic challenges in identifying patients with infective endocarditis (IE).
  • The HANDOC score was developed to stratify IE risk in NBHS bacteremia patients.
  • External validation of the HANDOC score is crucial for its clinical utility.

Purpose of the Study:

  • To validate the diagnostic performance of the HANDOC score in an external cohort of patients with NBHS bacteremia.
  • To assess the HANDOC score's ability to identify patients at low risk for infective endocarditis.

Main Methods:

  • Retrospective analysis of 68 patients with NBHS bacteremia from a Danish center (March-September 2016).
  • Data collection included patient characteristics and components of the HANDOC score.
  • Classification of IE was based on Dukés criteria.

Main Results:

  • 16 out of 68 patients (23.5%) fulfilled Dukés criteria for IE.
  • All patients with IE (16/16) had a HANDOC score above the predefined cut-off.
  • The HANDOC score demonstrated 100% sensitivity and 62% specificity for IE detection in this cohort.

Conclusions:

  • The HANDOC score exhibits excellent sensitivity (100%) and acceptable specificity (62%) in an external, prospectively enrolled cohort.
  • These findings support the clinical implementation of the HANDOC score to identify low-risk IE patients.
  • The HANDOC score may help guide decisions to omit echocardiography in select NBHS bacteremia cases.

Keywords:
Endocarditisbacteraemiaechocardiographymanagement scorestreptococcus

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