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首页> 外文期刊>BMC Medical Informatics and Decision Making >How good is our diagnostic intuition? Clinician prediction of bacteremia in critically ill children
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How good is our diagnostic intuition? Clinician prediction of bacteremia in critically ill children

机译：我们的诊断直觉有多好？临床医生预测危重儿童的菌血症

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Clinical intuition and nonanalytic reasoning play a major role in clinical hypothesis generation; however, clinicians’ intuition about whether a critically ill child is bacteremic has not been explored. We endeavored to assess pediatric critical care clinicians’ ability to predict bacteremia and to evaluate what affected the accuracy of those predictions. We conducted a retrospective review of clinicians’ responses to a sepsis screening tool (“Early Sepsis Detection Tool” or “ESDT”) over 6?months. The ESDT was completed during the initial evaluation of a possible sepsis episode. If a culture was ordered, they were asked to predict if the culture would be positive or negative. Culture results were compared to predictions for each episode as well as vital signs and laboratory data from the preceding 24?h. From January to July 2017, 266 ESDTs were completed. Of the 135 blood culture episodes, 15% of cultures were positive. Clinicians correctly predicted patients with bacteremia in 82% of cases, but the positive predictive value was just 28% as there was a tendency to overestimate the presence of bacteremia. The negative predictive value was 96%. The presence of bandemia, thrombocytopenia, and abnormal CRP were associated with increased likelihood of correct positive prediction. Clinicians are accurate in predicting critically ill children whose blood cultures, obtained for symptoms of sepsis, will be negative. Clinicians frequently overestimate the presence of bacteremia. The combination of evidence-based practice guidelines and bedside judgment should be leveraged to optimize diagnosis of bacteremia.
机译：临床直觉和非分析推理在临床假设生成中发挥了重要作用;然而，临床医生的直觉尚未探讨危重儿童是否是菌血症。我们努力评估儿科关键护理临床医生预测菌血症并评估影响这些预测的准确性的能力。我们对临床医生的回顾进行了回顾性审查，对败血症筛查工具（“早期败血症检测工具”或“ESDT”）超过6？几个月。 ESDT在可能的败血症发作的初步评估期间完成。如果订购了文化，他们被要求预测文化是积极的还是消极的。将培养结果与每个发作的预测进行了比较，以及前24个中的生命体征和实验室数据。从2017年1月到7月，266次ESDTS完成。在135个血液培养发作中，15％的培养物是阳性的。临床医生在82％的病例中正确预测患有菌血症的患者，但阳性预测值仅为28％，因为倾向于高估菌血症的存在。负面预测值为96％。存在带血症，血小板减少症和异常CRP与正确阳性预测的可能性增加有关。临床医生准确预测患有败血症症状的血液培养的危重儿童将是消极的。临床医生经常高估菌血症的存在。应利用基于证据的实践指南和床头判决的组合来优化菌血症的诊断。

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