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Validation of a bacteremia prediction model
J M Mylotte1, M A Pisano, S Ram
1Department of Medicine, School of Medicine and Biomedical Sciences, State University of New York at Buffalo, USA.
Objective:
To validate a previously published model for predicting bacteremia in hospitalized patients.
Design:
Application of a published bacteremia prediction model to a prospective validation cohort of patients and comparison of its predictability to that found in the derivation cohort.
Setting:
Urban, university-affiliated, 550-bed public hospital.
Patients:
The validation cohort consisted of 342 patients with 559 blood culture episodes between October 14, 1992, and December 5, 1992. Each blood culture episode was scored based on the presence or absence of seven predictors of bacteremia and the findings compared with published results (derivation cohort).
Interventions:
None.
Results:
Application of the bacteremia prediction model to the validation cohort identified episodes with a low risk (3%) and a high risk (17%) for true bacteremia, similar to the findings in the derivation cohort (1% and 16%, respectively). Comparison of the predictions of the model in the two cohorts by receiver operator characteristic curve analysis revealed that the overall predictability of the model in the validation cohort was not as good as in the derivation cohort.
Conclusions:
Although the bacteremia prediction model did not perform as well overall in the validation cohort, the model still was able to clearly define two extreme groups: those with a low risk and those with a high risk for true bacteremia. This predictive capability may aid physicians in prescribing empiric antimicrobial therapy and also may be useful to hospital epidemiologists in assessing quality of care.