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  • Using machine learning to predict blood culture outcomes in the emergency department: a single-centre, retrospective, observational study

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Emergency medicine
Original research
Using machine learning to predict blood culture outcomes in the emergency department: a single-centre, retrospective, observational study
  1. Anneroos W Boerman1,2,
  2. Michiel Schinkel1,3,
  3. Lotta Meijerink4,
  4. Eva S van den Ende1,
  5. Lara CA Pladet1,
  6. Martijn G Scholtemeijer4,
  7. Joost Zeeuw4,
  8. Anuschka Y van der Zaag1,
  9. Tanca C Minderhoud1,
  10. Paul W G Elbers5,
  11. W Joost Wiersinga3,6,
  12. Robert de Jonge2,
  13. Mark HH Kramer7,
  14. Prabath W B Nanayakkara1
  1. 1Section General and Acute Internal Medicine, Department of Internal Medicine, Amsterdam Public Health Research Institute, Amsterdam UMC Location VUmc, Amsterdam, The Netherlands
  2. 2Department of Clinical Chemistry, Amsterdam UMC Location VUmc, Amsterdam, The Netherlands
  3. 3Center for Experimental and Molecular Medicine, Amsterdam UMC Location AMC, Amsterdam, The Netherlands
  4. 4Pacmed, Amsterdam, The Netherlands
  5. 5Department of Intensive Care Medicine, Amsterdam Medical Data Science, Amsterdam Cardiovascular Science, Amsterdam Infection and Immunity Institute, Amsterdam UMC Location VUmc, Amsterdam, The Netherlands
  6. 6Section Infectious Diseases, Department of Internal Medicine, Amsterdam UMC Location AMC, Amsterdam, The Netherlands
  7. 7Board of Directors, Amsterdam UMC, Vrije Universiteit, Amsterdam, The Netherlands
  1. Correspondence to Professor Prabath W B Nanayakkara; p.nanayakkara{at}amsterdamumc.nl

Abstract

Objectives To develop predictive models for blood culture (BC) outcomes in an emergency department (ED) setting.

Design Retrospective observational study.

Setting ED of a large teaching hospital in the Netherlands between 1 September 2018 and 24 June 2020.

Participants Adult patients from whom BCs were collected in the ED. Data of demographic information, vital signs, administered medications in the ED and laboratory and radiology results were extracted from the electronic health record, if available at the end of the ED visits.

Main outcome measures The primary outcome was the performance of two models (logistic regression and gradient boosted trees) to predict bacteraemia in ED patients, defined as at least one true positive BC collected at the ED.

Results In 4885 out of 51 399 ED visits (9.5%), BCs were collected. In 598/4885 (12.2%) visits, at least one of the BCs was true positive. Both a gradient boosted tree model and a logistic regression model showed good performance in predicting BC results with area under curve of the receiver operating characteristics of 0.77 (95% CI 0.73 to 0.82) and 0.78 (95% CI 0.73 to 0.82) in the test sets, respectively. In the gradient boosted tree model, the optimal threshold would predict 69% of BCs in the test set to be negative, with a negative predictive value of over 94%.

Conclusions Both models can accurately identify patients with low risk of bacteraemia at the ED in this single-centre setting and may be useful to reduce unnecessary BCs and associated healthcare costs. Further studies are necessary for validation and to investigate the potential clinical benefits and possible risks after implementation.

  • diagnostic microbiology
  • accident & emergency medicine
  • internal medicine

Data availability statement

Data are available on reasonable request. The data that support the findings of this study are available from the corresponding author on a reasonable request and when allowed by local privacy regulations.

http://creativecommons.org/licenses/by-nc/4.0/

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

http://dx.doi.org/10.1136/bmjopen-2021-053332

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    Data availability statement

    Data are available on reasonable request. The data that support the findings of this study are available from the corresponding author on a reasonable request and when allowed by local privacy regulations.

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    Footnotes

    • AWB and MS contributed equally.

    • Contributors AWB and MS contributed equally to this paper. PWBN was the principal investigator and guarantor of the study. AWB, MS, LCAP and PWBN designed the study. ESvdE, LCAP, AYvdZ, PWGE, MHHK, AWB, MS and PWBN contributed to the acquisition of data. LM, JZ, MGS, AWB, MS, WJW and PWBN did the preparation of the data. LM, JZ and MGS were responsible for analysis of the data. AWB, MS, PWBN, TCM, PWGE and RdJ contributed to the interpretation of the data. AWB, MS and LM drafted the first version of the manuscript. All authors revised the manuscript and approved the final version for publication.

    • Funding This project was funded by a research grant (no grant number available) from the Dutch federation for acute internal medicine (NVIAG).

    • Disclaimer The funder had no involvement in any part of the study.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.