BACKGROUND Although optimal utilization of blood cultures has been studied in populations, including emergency room and intensive care patients, less is known about the use of blood cultures in populations consisting exclusively of patients on a medical service. OBJECTIVE To identify the physician‐selected indication and yield of blood cultures ordered after hospitalization to an acute medical service and to identify populations in which blood cultures may not be necessary. DESIGN, SETTING, AND PATIENTS A prospective cohort study was performed at a single Veterans Affairs Medical Center from October 1, 2014 through April 15, 2015. Participants included all hospitalized patients on a medical service for whom a blood culture was ordered. MEASUREMENTS The main outcomes were the rate of true positive blood cultures and the predictors of true positive cultures. RESULTS The true positive rate was 3.6% per order. The most common physician‐selected indications were fever and leukocytosis, neither of which alone was highly predictive of true positive blood cultures. The only indication significantly associated with a true positive blood culture was “follow‐up previous positive” (likelihood ratio [LR]+ 3.4, 95% confidence interval [CI]: 1.8‐6.5). The only clinical predictors were a working diagnosis of bacteremia/endocarditis (LR+ 3.7, 95% CI: 2.5‐5.7) and absence of antibiotic exposure within 72 hours of the culture (LR+ 2.4, 95% CI: 1.2‐4.9). CONCLUSIONS The rate of true positive blood cultures among patients on a medical service was lower than previously studied. Using objective and easily obtainable clinical characteristics, including antibiotic exposure and working diagnosis, may improve the likelihood of true positive blood cultures. Journal of Hospital Medicine 2016;11:336–340. © 2016 Society of Hospital Medicine
BACKGROUND Delirium is common in hospitalized patients and warrants early diagnosis and treatment. Often the evaluation of delirium includes head computed tomography imaging. However, in hospitalized medical patients, the yield of head computed tomography is unknown. OBJECTIVE To determine the diagnostic yield of head computed tomography when evaluating a hospitalized medical patient with delirium in the absence of a recent fall, head trauma, or new neurologic deficit. DESIGN AND SETTING Retrospective medical record review at a large academic medical center in Boston, Massachusetts. PARTICIPANTS We reviewed all medical records for head computed tomography scans performed from January 2010 through November 2012 in patients on the general medicine or medical subspecialties units. MAIN OUTCOMES A “positive” head computed tomography was defined as an intracranial process that could explain delirium. An “equivocal” head computed tomography was defined as the presence of a finding of unclear significance in relation to delirium. RESULTS There were 398 patients hospitalized for >24 hours who underwent head computed tomography for delirium. Two hundred twenty head computed tomography studies met eligibility criteria, with 6 (2.7%) positive and 4 (1.8%) equivocal results. All positive and equivocal findings resulted in change in management. CONCLUSIONS The diagnostic yield of head computed tomography in determining the cause of delirium in hospitalized patients is low. Due to the low rate of positive findings, head imaging is unnecessary in the majority of cases of delirium. However, there may be a subset of high‐risk individuals in which head imaging is indicated. Journal of Hospital Medicine 2014;9:497–501. © 2014 Society of Hospital Medicine
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