Clinical use of the erythrocyte sedimentation rate in the evaluation of febrile intravenous drug users.
OBJECTIVE
To investigate the use of the erythrocyte sedimentation rate in the evaluation of febrile IV drug users.


METHODS
Prospective observational cohort study.


METHODS
Municipal hospital emergency department.


METHODS
One hundred six IV drug users aged 18 years or older, with rectal temperatures of 37.8 C or more.


METHODS
Clinical and laboratory variables were obtained by trained research assistants, using a standardized data collection instrument.


RESULTS
The erythrocyte sedimentation rate was the only variable consistently associated with illness severity in both the univariate and multivariable analyses (P < .0001). At an erythrocyte sedimentation rate of 100 mm/hr or more, the test had a specificity of 96% (95% confidence interval, 81% to 100%). In contrast, the erythrocyte sedimentation rate displayed a relatively poor sensitivity at low values (88% [95% confidence interval, 77% to 95%] at an erythrocyte sedimentation rate less than 20).


CONCLUSIONS
An erythrocyte sedimentation rate of 100 or more should be regarded as a marker for serious illness in IV drug users with fever, but a "normal" erythrocyte sedimentation rate of less than 20 does not reliably exclude the presence of serious disease in this patient population.
Gallagher
E J
EJ
Department of Medicine, Yale University School of Medicine, New Haven, Connecticut.
Gennis
P
P
Brooks
F
F
D000328:Adult; D001799:Blood Sedimentation; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D005334:Fever / Q000097:blood*; D006746:Hospital Bed Capacity, 500 and over; D006773:Hospitals, Municipal / Q000706:statistics & numerical data; D006801:Humans; D016015:Logistic Models; D009519:New York City; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D015819:Substance Abuse, Intravenous / Q000097:blood*