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Related Concept Videos

Assessment of the Gastrointestinal System I: Subjective Data01:17

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Assessing the gastrointestinal (GI) system is a complex process that begins with collecting subjective data. This data, collected through patient interviews, provides crucial insights into the patient's health history, perception patterns, and lifestyle habits, all contributing significantly to GI health.
Health History
The initial step in assessing the GI system is obtaining a comprehensive health history. This includes inquiring about the patient's history or presence of problems...
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External Validation and Comparison of Clostridioides difficile Severity Scoring Systems.

D Alexander Perry1,2, Daniel Shirley3, Dejan Micic4

  • 1Department of Internal Medicine, Division of Infectious Diseases, University of Michigan, Ann Arbor, Michigan, USA.

Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America
|August 30, 2021
PubMed
Summary

No current Clostridioides difficile infection (CDI) severity scores reliably predict adverse outcomes across multiple institutions. External validation is crucial for these predictive models in clinical practice.

Keywords:
CDIsevere Clostridioides difficile infectiontoxic megacolon

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Area of Science:

  • Infectious Diseases
  • Clinical Epidemiology
  • Health Outcomes Research

Background:

  • Clostridioides difficile infection (CDI) poses a significant clinical challenge, necessitating accurate prediction of severe outcomes.
  • Existing risk scores for severe CDI are often developed at single institutions and lack external validation.
  • Multicenter validation is essential to assess the generalizability and reliability of these predictive tools.

Purpose of the Study:

  • To externally validate previously published risk scores for predicting severe outcomes in a multicenter Clostridioides difficile infection (CDI) cohort.
  • To compare the performance of existing CDI severity scores against each other and against Infectious Diseases Society of America (IDSA) guidelines.
  • To assess the stability and predictive accuracy of CDI risk scores across different institutional settings.

Main Methods:

  • Retrospective analysis of 4 inpatient cohorts with CDI from 3 distinct academic medical centers (University of Michigan, University of Chicago, University of Wisconsin).
  • Inclusion of 3646 patients diagnosed with CDI between 2010 and 2016.
  • Assessment of 14 published CDI severity scores and 2 IDSA guideline definitions for predicting a composite outcome of ICU admission, colectomy, and/or 30-day CDI-attributed death.

Main Results:

  • The performance of assessed CDI severity scores varied significantly within individual cohorts and in the combined multicenter dataset (mean AuROC, 0.61; range, 0.53-0.66).
  • Only half of the evaluated scores demonstrated predictive performance comparable to or exceeding the IDSA severe and fulminant CDI definitions (AuROCs of 0.64 and 0.63, respectively).
  • Most scoring systems exhibited a higher proportion of false positives than true positives in the combined cohort (mean, 81.5%).

Conclusions:

  • No existing published Clostridioides difficile infection (CDI) severity score demonstrated consistent and robust predictive ability for adverse outcomes across multiple institutions.
  • The findings highlight the limitations of current CDI risk scores in real-world, multicenter settings.
  • Further research is needed to develop and validate more accurate and generalizable predictive models for severe CDI.