Prediction of bloodstream infection using triage variables in the emergency department: retrospective derivation and validation cohort
Consider using a triage-based score like GOTHIC when managing febrile patients to help stratify those most likely to have BSI, potentially optimizing blood culture draws. Remember that the inclusion of 'protective' complaints actually lowers the risk score, which is an important nuance at the bedside. While useful for prediction, this tool should complement clinical judgment and not replace it.
This retrospective study introduces the GOTHIC score, a novel tool designed to predict bloodstream infection (BSI) risk in febrile emergency department patients based on variables obtainable immediately upon triage. Recognizing that blood cultures are often drawn with limited diagnostic yield, the authors developed this scoring system using seven easily assessed factors. The score incorporates elements such as age greater than or equal to 75 years, tachycardia exceeding 90 beats per minute, systolic blood pressure less than 38 degrees Celsius, having isolated fever as the chief complaint, and specific protective complaints. The derivation and validation cohorts demonstrated that this simple risk stratification tool has utility in guiding further workup for suspected sepsis.