title: Blood culture use in the emergency department in patients hospitalized with respiratory symptoms due to a nonpneumonia illness.
abstract: BACKGROUND
  Guidelines and performance measures recommend obtaining blood cultures in selected patients hospitalized with community-acquired pneumonia (CAP). Due to inherent diagnostic uncertainty, there may be spillover effects of these recommendations on other conditions that resemble pneumonia.
  
  
  METHODS
  Using data from the 2002 to 2010 National Hospital Ambulatory Medical Care Survey, a nationally representative sample of emergency department (ED) visits in the United States, we analyzed trends in obtaining cultures in patients hospitalized with respiratory symptoms due to a nonpneumonia illness using linear regression.
  
  
  RESULTS
  The most common primary admission diagnoses for these visits included heart failure (16%), chronic obstructive pulmonary disease (13%), and chest pain (12%). The proportion of cultures collected in the ED during these visits increased from 10% (95% confidence interval [CI]: 7%-14%) in 2002 to 20% (95% CI: 16%-26%) in 2010 (P<0.001 for the trend). This represented a parallel increase compared to patients hospitalized with CAP (P=0.12 for the difference in trends).
  
  
  CONCLUSIONS
  The increase in collecting cultures in the ED in patients hospitalized with respiratory symptoms due to a nonpneumonia illness suggests an important potential unintended consequence of blood culture recommendations for CAP. More attention to the judicious use of blood cultures to reduce harm and costs is needed.
authors.affiliation: Division of General Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas.
authors.forename: Anil N
authors.initials: AN
authors.lastname: Makam
authors.forename: Andrew D
authors.initials: AD
authors.lastname: Auerbach
authors.forename: Michael A
authors.initials: MA
authors.lastname: Steinman
mesh_terms: D000368:Aged; D001769:Blood / Q000382:microbiology*; D017714:Community-Acquired Infections / Q000097:blood* / Q000453:epidemiology / Q000382:microbiology; D003430:Cross-Sectional Studies; D004636:Emergency Service, Hospital; D005260:Female; D005500:Follow-Up Studies; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D015994:Incidence; D007297:Inpatients; D008297:Male; D008875:Middle Aged; D012140:Respiratory Tract Diseases / Q000097:blood* / Q000175:diagnosis / Q000453:epidemiology; D012189:Retrospective Studies; D014481:United States / Q000453:epidemiology
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