title: How do bacteraemic patients present to the emergency department and what is the diagnostic validity of the clinical parameters; temperature, C-reactive protein and systemic inflammatory response syndrome?
abstract: OBJECTIVE
  Although blood cultures are often ordered based on the presence of fever, it is a clinical challenge to identify patients eligible for blood cultures. Our aim was to evaluate the diagnostic value of temperature, C-reactive-protein (CRP), and Systemic Inflammatory Response Syndrome (SIRS) to identify bacteraemic patients in the Medical Emergency Department (MED).
  
  
  METHODS
  A population-based cohort study including all adult patients at the MED at Odense University Hospital between August 1st 2009 - August 31st 2011.
  
  
  RESULTS
  11,988 patients were admitted to the MED within the study period. Blood cultures were performed on 5,499 (45.9%) patients within 2 days of arrival, of which 418 (7.6%) patients were diagnosed with bacteraemia. This corresponded to 3.5% of all patients. 34.1% of the bacteraemic patients had a normal rectal temperature (36.0°-38.0 °C) recorded at arrival, 32.6% had a CRP < 100 mg/L and 28.0% did not fulfil the SIRS criteria.For a temperature cut-point of >38.0 °C sensitivity was 0.64 (95% CI 0.59-0.69) and specificity was 0.81 (0.80-0.82) to identify bacteraemic patients.
  
  
  CONCLUSIONS
  One third of the acute medical bacteraemic patients had a normal temperature at arrival to the MED. A normal temperature combined with a CRP < 100 mg/L and no SIRS criteria, ruled out bacteraemia.
authors.affiliation: Department of Emergency Medicine, Odense University Hospital, Sdr, Boulevard 29, 5000 Odense C, Denmark. klindvig4@gmail.com.
authors.forename: Katrine Prier
authors.initials: KP
authors.lastname: Lindvig
authors.forename: Daniel Pilsgaard
authors.initials: DP
authors.lastname: Henriksen
authors.forename: Stig Lønberg
authors.initials: SL
authors.lastname: Nielsen
authors.forename: Thøger Gorm
authors.initials: TG
authors.lastname: Jensen
authors.forename: Hans Jørn
authors.initials: HJ
authors.lastname: Kolmos
authors.forename: Court
authors.initials: C
authors.lastname: Pedersen
authors.forename: Pernille Just
authors.initials: PJ
authors.lastname: Vinholt
authors.forename: Annmarie Touborg
authors.initials: AT
authors.lastname: Lassen
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016470:Bacteremia / Q000097:blood / Q000175:diagnosis* / Q000503:physiopathology; D001831:Body Temperature; D002097:C-Reactive Protein / Q000378:metabolism*; D003937:Diagnosis, Differential; D004636:Emergency Service, Hospital; D005260:Female; D005500:Follow-Up Studies; D006760:Hospitalization; D006801:Humans; D008297:Male; D008875:Middle Aged; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012720:Severity of Illness Index; D018746:Systemic Inflammatory Response Syndrome / Q000097:blood / Q000175:diagnosis* / Q000503:physiopathology; D055815:Young Adult
chemical_list: D002097:C-Reactive Protein