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Assessing diagnostic criteria for active infective endocarditis
J A Berlin1, E Abrutyn, B L Strom
1Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania School of Medicine, Philadelphia 19104-6095.
The American Journal of Cardiology
|May 1, 1994
Summary
Expert agreement on infective endocarditis (IE) diagnosis was high for non-cases but lower for specific IE classifications. Positive blood cultures strongly predicted IE diagnosis, with experts sometimes relying on this alone.
Area of Science:
- Infectious Diseases
- Clinical Medicine
- Medical Diagnostics
Background:
- Infective endocarditis (IE) diagnosis can be challenging.
- Standardized criteria for IE classification are crucial for consistent patient management.
- Expert clinical judgment plays a significant role in diagnosing complex conditions like IE.
Purpose of the Study:
- To evaluate inter-expert agreement in classifying infective endocarditis (IE) cases.
- To identify clinical characteristics influencing expert IE diagnosis.
- To compare expert classification using clinical judgment versus a modified standard definition.
Main Methods:
- Prospective identification of 151 patients with a discharge diagnosis of IE from 54 hospitals.
- Independent review of abstracted hospital records by three infectious disease experts.
- Classification of patients as definite, probable, possible IE, or probable noncase using clinical judgment and a modified standard definition.
Main Results:
- Experts were more likely to classify patients as definite IE using clinical judgment than a modified standard definition.
- High agreement (92-95%) was observed when distinguishing non-IE cases.
- Lower agreement (40-58%) occurred for specific IE case classifications.
- Positive blood cultures and organism type were strong predictors of IE classification.
Conclusions:
- Infective endocarditis diagnosis relies heavily on expert interpretation, particularly with positive blood cultures.
- Clinical judgment alone can lead to definitive IE diagnoses.
- Echocardiographic findings are essential for confirmation when blood cultures are ambiguous.