Dr. Lin is an attending emergency physician and a fellow in the Division of Health Policy Research and Translation in the Department of Emergency Medicine, Brigham and Women’s Hospital in Boston. She also serves as an instructor at Harvard Medical School.
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ACEP Now: Vol 33 – No 09 – September 2014
Dr. Schuur is vice chair of quality and safety and chief of the Division of Health Policy Research and Translation in the Department of Emergency Medicine, Brigham & Women’s Hospital in Boston. He also serves as assistant professor at Harvard Medical School.
References
- Centers for Disease Control and Prevention. National Hospital Ambulatory Medical Care Survey: 2010 Emergency Department Summary Tables. Centers for Disease Control and Prevention Web site. Available at: www.cdc.gov/nchs/data/ahcd/nhamcs_emergency/2010_ed_web_tables.pdf. Accessed July 30, 2014.
- Centers for Medicare & Medicaid Services. 2014 Clinical Laboratory Fee Schedule. Centers for Medicare & Medicaid Services Web site. Available at: http://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/ClinicalLabFeeSched/clinlab.html. Accessed July 30, 2014.
- Bates DW, Cook EF, Goldman L, et al. Predicting bacteremia in hospitalized patients: a prospectively validated model.Ann Intern Med. 1990;113:495-500.
- Alahmadi YM, Aldeyab MA, McElnay JC, et al. Clinical and economic impact of contaminated blood cultures within the hospital setting. J Hosp Infect. 2011;77:233-6.
- Bates DW, Goldman L, Lee TH. Contaminant blood cultures and resource utilization: the true consequences of false-positive results. JAMA. 1991;265:365-369.
- Mandell LA, Wunderink RG, Anzueto A, et al. Infectious Diseases Society of America/American Thoracic Society consensus guidelines on the management of community-acquired pneumonia in adults. Clin Infect Dis. 2007;44(Suppl. 2):S27-S72.
- Benenson RS, Kepner AM, Pyle DN 2nd, et al. Selective use of blood cultures in emergency department pneumonia patients. J Emerg Med. 2007;33:1-8.
- Bradley JS, Byington CL, Shah SS, et al. Executive summary: the management of community-acquired pneumonia in infants and children older than 3 months of age: clinical practice guidelines by the Pediatric Infectious Diseases Society and the Infectious Diseases Society of America. Clin Infect Dis. 2011;53:617.
- Perl B, Gottehrer NP, Raveh D, et al. Cost-effectiveness of blood cultures for adult patients with cellulitis.Clin Infect Dis. 1999;29:1483-1488.
- Pasternak EL, Topinka MA. Blood cultures in pyelonephritis: do results change therapy? Acad Emerg Med. 2000;7:1170.
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- International Guidelines for Management of Severe Sepsis and Septic Shock: 2012. Surviving Sepsis Campaign. Society of Critical Care Medicine Web site. Available at: http://www.sccm.org/Documents/SSC-Guidelines.pdf. Accessed August 11, 2014.
- Baron EJ, Miller JM, Weinstein MP, et al. A guide to utilization of the microbiology laboratory for diagnosis of infectious diseases: 2013 recommendations by the Infectious Diseases Society of America (IDSA) and the American Society for Microbiology (ASM). Clin Infect Dis. 2013;57:e22–e121.
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2 Responses to “Blood Culture Testing: Send Samples Selectively to Lower Costs, Medico-Legal Risk”
October 4, 2014
CuloochGreat article!
In future versions would be useful to discuss the cost of false positive cultures (usually $4000-7000 per false positive in a hospitalized patient)
Also it is not so important whether or not a culture is positive but rather how often does it change management. While 4% of ED drawn blood cultures may be positive (and half of those being false positives) a positive culture almost never prompts a change in abx. When it does, it is almost always in a immunosuppressed patient orthose with severe sepsis/septic shock
June 10, 2015
Delores LyonWow, I had no idea that blood cultures could be so inaccurate. With a false positive testing rate of 40%, that is a lot of unnecessary follow up. In my opinion, if I was sick for some reason, I would probably want my doctor to forego something like this. The last thing I want is unnecessary medical bills.