Recognition of Serious Infections in the Elderly

Study Overview
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Brief Summary
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The aim of this diagnostic accuracy study is to develop a clinical prediction rule based on signs, symptoms, patient characteristics and blood tests, to be used in ambulatory care to help physicians safely rule out a serious infection in an older patient. It will be performed in general practices and emergency care departments across Flanders (Belgium).

Detailed Description
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This is a cross-sectional diagnostic cohort study in older adults presenting to ambulatory care, including a follow-up period of 30 days. This study will be used to construct an algorithm consisting of clinical features and blood test results to identify serious infections. The study will run in ambulatory care in Flanders. Recruitment is expected to last 2.5 years, with each patient entering the study only once. Older adults will be approached for possible participation in the study by practice staff. There is only one study visit. Those who agree to participate via written informed consent will have demographics and clinical features recorded. A blood sample will be taken in all participants on study entry. Follow-up information for all participants will be collected using electronic medical record notes (EMD) and patient diaries. Treatment and other management decisions will be left to the treating physicians' discretion.

Official Title
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Recognition of Serious Infections in the Elderly: Developing a Diagnostic Prediction Rule Based on Clinical Features and Blood Tests to Help Physicians Safely Rule Out a Serious Infection in an Older Patient Presenting to Ambulatory Care

Conditions
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Infection

Intervention / Treatment
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* Diagnostic Test: signs and symptoms, blood tests


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Aged 65 years or older Presenting to a general practice with an acute illness with a maximum duration of 10 days since onset Suspicion of infectious disease (this may include suspicion of an acute exacerbation of COPD) Patient or proxy of the patient is willing and able to give informed consent for participation. Exclusion Criteria: The participant may not enter the study if any of the following apply: Too clinically unstable to waste time on study procedures Indwelling catheter in situ Immunocompromised or currently receiving medication for systemic immune-suppression, including corticosteroids Being admitted to hospital for longer than 24 hours less than 7 days before study entry, or having undergone surgery in the previous 30 days Living in a nursing home (both short term and long term stay) (only in general practice cohort) Patient was already included in the study

Ages Eligible for Study
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Minimum Age: 65 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Emergency care<br>Consecutive enrolment of acutely ill older adults in emergency care | Diagnostic Test: signs and symptoms, blood tests<br>* signs and symptoms as observed by the treating physician + blood tests (CRP, Procalcitonin, White blood cell count)<br>|
| General practice<br>Consecutive enrolment of acutely ill older adults in general practice | Diagnostic Test: signs and symptoms, blood tests<br>* signs and symptoms as observed by the treating physician + blood tests (CRP, Procalcitonin, White blood cell count)<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Diagnostic accuracy 1 | Sensitivity and specificity of clinical prediction rules that are based on signs, symptoms, patient characteristics with and without blood tests, to be used in ambulatory care to help physicians safely rule out a serious infection in an older patient | 30 days | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Diagnostic accuracy 2 | Sensitivity, specificity, positive and negative predictive value and likelihood ratios of individual signs, symptoms, patient characteristics and blood tests for diagnosing a serious infection in persons aged ≥65 years | 30 days | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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geriatric, diagnosis, ambulatory care, general practice, emergency care