TY - JOUR
T1 - Consensus Recommendations for Blood Culture Use in Critically Ill Children Using a Modified Delphi Approach
AU - Woods-Hill, Charlotte Z.
AU - Koontz, Danielle W.
AU - Voskertchian, Annie
AU - Xie, Anping
AU - Shea, Judy
AU - Miller, Marlene R.
AU - Fackler, James C.
AU - Milstone, Aaron M.
N1 - Funding Information:
Drs. Woods-Hill’s, Koontz’s, Voskertchian’s, Xie’s, and Milstone’s institutions received funding from the Agency for Healthcare Research and Quality (AHRQ). Dr. Woods-Hill’s institution received funding from the National Institutes of Health (NIH). Drs. Woods-Hill and Xie received support for article research from the NIH. Drs. Woods-Hill and Milstone received support for article research from the AHRQ. Dr. Milstone’s institution received funding from Merck. The remaining authors have disclosed that they do not have any potential conflicts of interest.
Funding Information:
Supported, in part, by the Agency for Healthcare Research and Quality (grant 1R18HS025642). Dr. Milstone also receives support from K24AI141580. Dr. Woods-Hill also receives support from the National Heart, Lung, And Blood Institute of the National Institutes of Health under Award Number K23HL151381. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.
Publisher Copyright:
© 2021 Lippincott Williams and Wilkins. All rights reserved.
PY - 2021
Y1 - 2021
N2 - Objectives: Blood cultures are fundamental in evaluating for sepsis, but excessive cultures can lead to false-positive results and unnecessary antibiotics. Our objective was to create consensus recommendations focusing on when to safely avoid blood cultures in PICU patients. Design: A panel of 29 multidisciplinary experts engaged in a two-part modified Delphi process. Round 1 consisted of a literature summary and an electronic survey sent to invited participants. In the survey, participants rated a series of recommendations about when to avoid blood cultures on five-point Likert scale. Consensus was achieved for the recommendation(s) if 75% of respondents chose a score of 4 or 5, and these were included in the final recommendations. Any recommendations that did not meet these a priori criteria for consensus were discussed during the in-person expert panel review (Round 2). Round 2 was facilitated by an independent expert in consensus methodology. After a review of the survey results, comments from round 1, and group discussion, the panelists voted on these recommendations in real-time. Setting: Experts' institutions; in-person discussion in Baltimore, MD. Subjects: Experts in pediatric critical care, infectious diseases, nephrology, oncology, and laboratory medicine. Interventions: None. Measurements and Main Results: Of the 27 original recommendations, 18 met criteria for achieving consensus in Round 1; some were modified for clarity or condensed from multiple into single recommendations during Round 2. The remaining nine recommendations were discussed and modified until consensus was achieved during Round 2, which had 26 real-time voting participants. The final document contains 19 recommendations. Conclusions: Using a modified Delphi process, we created consensus recommendations on when to avoid blood cultures and prevent overuse in the PICU. These recommendations are a critical step in disseminating diagnostic stewardship on a wider scale in critically ill children.
AB - Objectives: Blood cultures are fundamental in evaluating for sepsis, but excessive cultures can lead to false-positive results and unnecessary antibiotics. Our objective was to create consensus recommendations focusing on when to safely avoid blood cultures in PICU patients. Design: A panel of 29 multidisciplinary experts engaged in a two-part modified Delphi process. Round 1 consisted of a literature summary and an electronic survey sent to invited participants. In the survey, participants rated a series of recommendations about when to avoid blood cultures on five-point Likert scale. Consensus was achieved for the recommendation(s) if 75% of respondents chose a score of 4 or 5, and these were included in the final recommendations. Any recommendations that did not meet these a priori criteria for consensus were discussed during the in-person expert panel review (Round 2). Round 2 was facilitated by an independent expert in consensus methodology. After a review of the survey results, comments from round 1, and group discussion, the panelists voted on these recommendations in real-time. Setting: Experts' institutions; in-person discussion in Baltimore, MD. Subjects: Experts in pediatric critical care, infectious diseases, nephrology, oncology, and laboratory medicine. Interventions: None. Measurements and Main Results: Of the 27 original recommendations, 18 met criteria for achieving consensus in Round 1; some were modified for clarity or condensed from multiple into single recommendations during Round 2. The remaining nine recommendations were discussed and modified until consensus was achieved during Round 2, which had 26 real-time voting participants. The final document contains 19 recommendations. Conclusions: Using a modified Delphi process, we created consensus recommendations on when to avoid blood cultures and prevent overuse in the PICU. These recommendations are a critical step in disseminating diagnostic stewardship on a wider scale in critically ill children.
KW - bacteremia
KW - blood culture
KW - clinical decision-making
KW - infection
KW - quality improvement
KW - sepsis
UR - http://www.scopus.com/inward/record.url?scp=85114986799&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85114986799&partnerID=8YFLogxK
U2 - 10.1097/PCC.0000000000002749
DO - 10.1097/PCC.0000000000002749
M3 - Article
C2 - 33899804
AN - SCOPUS:85114986799
SN - 1529-7535
SP - 774
EP - 784
JO - Pediatric Critical Care Medicine
JF - Pediatric Critical Care Medicine
ER -