Screening for Bacteremia in Trauma Patients: Traditional Markers Fall Short

Area of Science:

• Infectious Disease
• Trauma Critical Care
• Clinical Diagnostics

Background:

• Sepsis diagnosis in trauma patients is challenging due to altered physiology.
• Current screening methods for bacteremia in trauma patients result in overscreening.
• No definitive clinical signs or biomarkers accurately diagnose sepsis in this population.

Purpose of the Study:

• To evaluate the accuracy of current criteria for bacteremia screening in trauma patients.
• To identify independent predictors of bacteremia in trauma patients.

Main Methods:

• Retrospective analysis of adult trauma patients undergoing blood cultures (BCs) at a level I academic trauma center.
• Comparison of patients with positive BCs versus those with negative or false-positive BCs.
• False-positive BCs were defined as contaminated and not treated.

Main Results:

• Of 492 unique BC sets, 104 (21.1%) were positive, with 30 (28.8%) false positives, yielding a true-positive rate of 15%.
• Multivariable analysis identified central line presence and lactic acid as independent predictors of bacteremia.
• Procalcitonin (PCT) demonstrated poor predictive value (PPV 18%, NPV 91%).

Conclusions:

• Existing tools for bacteremia screening in trauma patients lead to overscreening.
• PCT may serve as a limited negative predictor for bacteremia.
• Development of alternative screening modalities is needed to mitigate negative patient and economic consequences of false-positive BCs.