Effective limitation of blood culture use in the burn unit
There is little data to support the use of blood culture (BC) testing in the burn patient. Clinical signs (fever, leukocytosis) may not reliably indicate infection; moreover, BC's are expensive, invasive and plagued by false positive results. A policy of critical evaluation of lab utilization w...
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Published in | Journal of burn care & rehabilitation Vol. 23; no. 3; p. 183 |
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Main Authors | , , , |
Format | Journal Article |
Language | English |
Published |
United States
01.05.2002
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Abstract | There is little data to support the use of blood culture (BC) testing in the burn patient. Clinical signs (fever, leukocytosis) may not reliably indicate infection; moreover, BC's are expensive, invasive and plagued by false positive results. A policy of critical evaluation of lab utilization was instituted in our burn unit in 1993. By 1997 the use of blood culture testing had decreased by 50%. A retrospective analysis of our change in BC utilization was undertaken to derive practice guidelines for usage of this test.
47 patients with BC testing in 1997 were compared to a cohort of 47 patients from 1993, representing a total of 441 BC episodes.
Comparison of 1993 and 1997 patients revealed no significant differences in patient characteristics or outcomes. The mean white blood cell count and maximum temperature on the day of culture were identical for both positive and negative BC episodes. However, BC's drawn during a state of shock were twice as likely to be positive. Patients who experienced positive BC's had larger burns, received more antibiotics, had more indwelling catheters, and had longer lengths of ventilator support and hospital stays.
Higher patient acuity or the presence of indwelling catheters increases the likelihood of a positive BC. Substantial limitation of BC's without observed changes in length of stay, ventilator days, or mortality suggests that this test can be safely limited without compromising patient outcomes. |
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AbstractList | There is little data to support the use of blood culture (BC) testing in the burn patient. Clinical signs (fever, leukocytosis) may not reliably indicate infection; moreover, BC's are expensive, invasive and plagued by false positive results. A policy of critical evaluation of lab utilization was instituted in our burn unit in 1993. By 1997 the use of blood culture testing had decreased by 50%. A retrospective analysis of our change in BC utilization was undertaken to derive practice guidelines for usage of this test.
47 patients with BC testing in 1997 were compared to a cohort of 47 patients from 1993, representing a total of 441 BC episodes.
Comparison of 1993 and 1997 patients revealed no significant differences in patient characteristics or outcomes. The mean white blood cell count and maximum temperature on the day of culture were identical for both positive and negative BC episodes. However, BC's drawn during a state of shock were twice as likely to be positive. Patients who experienced positive BC's had larger burns, received more antibiotics, had more indwelling catheters, and had longer lengths of ventilator support and hospital stays.
Higher patient acuity or the presence of indwelling catheters increases the likelihood of a positive BC. Substantial limitation of BC's without observed changes in length of stay, ventilator days, or mortality suggests that this test can be safely limited without compromising patient outcomes. |
Author | Saffle, Jeffrey Keen, Angela Knoblock, Lyn Edelman, Linda |
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BackLink | https://www.ncbi.nlm.nih.gov/pubmed/12032368$$D View this record in MEDLINE/PubMed |
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CitedBy_id | crossref_primary_10_1186_s41038_016_0038_8 crossref_primary_10_1097_BCR_0b013e3181d0f536 crossref_primary_10_1016_j_burns_2008_01_014 crossref_primary_10_14260_jemds_2017_1261 crossref_primary_10_1155_2018_5607932 crossref_primary_10_1016_j_burns_2006_10_390 crossref_primary_10_1097_BCR_0b013e3181c89f0b crossref_primary_10_1097_TA_0b013e318163c3e4 crossref_primary_10_1097_SHK_0b013e318237d6bf crossref_primary_10_14260_Jemds_2017_1087 crossref_primary_10_1016_j_burns_2010_05_009 crossref_primary_10_1017_ice_2017_191 crossref_primary_10_1097_BCR_0b013e31826450b5 |
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SubjectTerms | Adult Analysis of Variance Anti-Bacterial Agents - therapeutic use Bacteremia - diagnosis Blood - microbiology Burns - complications Case-Control Studies Chi-Square Distribution False Positive Reactions Female Hematologic Tests - utilization Humans Intensive Care Units Male Retrospective Studies United States |
Title | Effective limitation of blood culture use in the burn unit |
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