Table.
Predictors of Blood Culture Collection in the Emergency Department for Patients Hospitalized with Community-Acquired Pneumonia from 2007–2010
| Weighted % of visits with blood culture Unweighted N=792 |
Unadjusted OR (95% CI) | Adjusted ORa (95% CI) | |
|---|---|---|---|
| Demographics | |||
| Age, per 10 years | - | 0.95 (0.86–1.05) | 0.90 (0.77–1.05) |
| Sex | |||
| Male | 43 | 1 [Ref] | 1 [Ref] |
| Female | 51 | 1.41 (1.06–1.86) | 1.42 (1.01–2.00) |
| Race/ethnicity | |||
| White | 49 | 1 [Ref] | 1 [Ref] |
| Black | 39 | 0.66 (0.36–1.20) | 0.57 (0.28–1.14) |
| Other | 46 | 0.87 (0.52–1.48) | 1.09 (0.59–2.01) |
| Primary Payer | |||
| Commercial | 46 | 1 [Ref] | 1 [Ref] |
| Medicare | 47 | 1.04 (068–1.59) | 1.27 (0.77–2.11) |
| Medicaid | 36 | 0.68 (0.36–1.28) | 0.77 (0.37–1.59) |
| Other/Unknown | 60 | 1.81 (0.98–3.36) | 1.97 (1.05–3.69) |
| Clinical Characteristics | |||
| CRB-65b | |||
| 0 | 46 | 1 [Ref] | 1 [Ref] |
| 1 | 50 | 1.16 (0.76–1.78) | 1.22 (0.67–2.22) |
| 2–4 | 44 | 0.91 (0.50–1.67) | 0.98 (0.42–2.26) |
| Disposition Status | |||
| Non-ICU | 49 | 1 [Ref] | 1 [Ref] |
| ICU | 36 | 0.58 (0.35–0.96) | 0.53 (0.29–0.98) |
| Fever (≥ 100.4°F) | |||
| No | 46 | 1 [Ref] | 1 [Ref] |
| Yes | 50 | 1.15 (0.75–1.76) | 1.03 (0.64–1.65) |
| Hypoxia (< 90%) | |||
| No | 48 | 1 [Ref] | 1 [Ref] |
| Yes | 42 | 0.78 (0.50–1.24) | 0.83 (0.49–1.41) |
| Visit Characteristics | |||
| Triage status | |||
| Non-emergent | 45 | 1 [Ref] | 1 [Ref] |
| Emergent | 52 | 1.35 (0.92–1.99) | 1.41 (0.91–2.19) |
| Administered antibiotics in ED | |||
| No | 22 | 1 [Ref] | 1 [Ref] |
| Yes | 54 | 4.18 (2.57–6.80) | 3.30 (1.99–5.48) |
| Primary diagnosis is pneumonia | |||
| No | 35 | 1 [Ref] | 1 [Ref] |
| Yes | 53 | 2.09 (1.27–3.43) | 2.36 (1.46–3.80) |
| Number of tests/servicesc | |||
| 0–5 | 30 | 1 [Ref] | 1 [Ref] |
| 6–10 | 51 | 2.43 (1.51–3.93) | 2.04 (1.21–3.46) |
| > 10 | 62 | 3.83 (1.89–7.76) | 4.34 (2.00–9.43) |
| Year of visit | – | 1.09 (0.92–1.28) | 1.14 (0.94–1.38) |
| ED Characteristics | |||
| Region | |||
| West | 33 | 1 [Ref] | 1 [Ref] |
| Midwest | 53 | 2.11 (1.12–3.95) | 2.60 (1.35–5.00) |
| South | 49 | 2.26 (1.25–4.08) | 1.86 (0.98–3.51) |
| Northeast | 51 | 1.92 (1.15–3.49) | 2.90 (1.55–5.41) |
| Hospital Owner | |||
| Nonprofit | 46 | 1 [Ref] | 1 [Ref] |
| Government | 44 | 0.94 (0.48–1.81) | 1.14 (0.54–2.43) |
| Proprietary | 62 | 1.96 (1.05–3.65) | 2.92 (1.15–7.40) |
Abbreviations: ICU, intensive care unit; ED, emergency department
Weighted multivariate logistic regression model adjusted for all covariates listed above, accounting for complex survey design.
CRB-65 is a validated clinical prediction index that grades the severity of community-acquired pneumonia by 30-day mortality using four criteria: “C”onfusion, “R”espiratory rate ≥ 30/minute, systolic “B”lood pressure < 90 mmHg or diastolic “B”lood pressure < 60 mmHg, and age ≥ “65” years of age.6 Higher scores equate to greater risk of mortality. Confusion was defined by having one the following criteria: Glasgow Coma Scale < 15 (for years 2009–2010), not oriented to person, place, or time (for years 2007–2008), patient’s reason for visit coded as confusion, cognitive decline, change in mental status, disoriented, or altered level of consciousness, or a visit diagnosis was for alteration of consciousness (ICD-9 code 780.0) or altered mental status (ICD-9 code 780.97).
Tests or services included blood tests (i.e. electrolytes, liver function tests), imaging studies (i.e. radiography, ultrasound, computed tomography), and miscellaneous tests (i.e. urine studies, electrocardiogram). Panel blood tests, such as electrolytes, were counted as a single test. To avoid endogeneity of our predictor-outcome relationship, blood cultures were not included in the number of tests or services.