Skip to main content
Journal cover image

Comparing the Diagnostic Accuracy of Clinician Judgment to a Novel Host Response Diagnostic for Acute Respiratory Illness.

Publication ,  Journal Article
Jaffe, IS; Jaehne, AK; Quackenbush, E; Ko, ER; Rivers, EP; McClain, MT; Ginsburg, GS; Woods, CW; Tsalik, EL
Published in: Open Forum Infect Dis
December 2021

BACKGROUND: Difficulty discriminating bacterial from viral infections drives antibacterial misuse. Host gene expression tests discriminate bacterial and viral etiologies, but their clinical utility has not been evaluated. METHODS: Host gene expression and procalcitonin levels were measured in 582 emergency department participants with suspected infection. We also recorded clinician diagnosis and clinician-recommended treatment. These 4 diagnostic strategies were compared with clinical adjudication as the reference. To estimate the clinical impact of host gene expression, we calculated the change in overall Net Benefit (∆NB; the difference in Net Benefit comparing 1 diagnostic strategy with a reference) across a range of prevalence estimates while factoring in the clinical significance of false-positive and -negative errors. RESULTS: Gene expression correctly classified bacterial, viral, or noninfectious illness in 74.1% of subjects, similar to the other strategies. Clinical diagnosis and clinician-recommended treatment revealed a bias toward overdiagnosis of bacterial infection resulting in high sensitivity (92.6% and 94.5%, respectively) but poor specificity (67.2% and 58.8%, respectively), resulting in a 33.3% rate of inappropriate antibacterial use. Gene expression offered a more balanced sensitivity (79.0%) and specificity (80.7%), which corresponded to a statistically significant improvement in average weighted accuracy (79.9% vs 71.5% for procalcitonin and 76.3% for clinician-recommended treatment; P<.0001 for both). Consequently, host gene expression had greater Net Benefit in diagnosing bacterial infection than clinician-recommended treatment (∆NB=6.4%) and procalcitonin (∆NB=17.4%). CONCLUSIONS: Host gene expression-based tests to distinguish bacterial and viral infection can facilitate appropriate treatment, improving patient outcomes and mitigating the antibacterial resistance crisis.

Duke Scholars

Altmetric Attention Stats
Dimensions Citation Stats

Published In

Open Forum Infect Dis

DOI

ISSN

2328-8957

Publication Date

December 2021

Volume

8

Issue

12

Start / End Page

ofab564

Location

United States

Related Subject Headings

  • 3207 Medical microbiology
  • 3202 Clinical sciences
 

Citation

APA
Chicago
ICMJE
MLA
NLM
Jaffe, I. S., Jaehne, A. K., Quackenbush, E., Ko, E. R., Rivers, E. P., McClain, M. T., … Tsalik, E. L. (2021). Comparing the Diagnostic Accuracy of Clinician Judgment to a Novel Host Response Diagnostic for Acute Respiratory Illness. Open Forum Infect Dis, 8(12), ofab564. https://doi.org/10.1093/ofid/ofab564
Jaffe, Ian S., Anja K. Jaehne, Eugenia Quackenbush, Emily R. Ko, Emanuel P. Rivers, Micah T. McClain, Geoffrey S. Ginsburg, Christopher W. Woods, and Ephraim L. Tsalik. “Comparing the Diagnostic Accuracy of Clinician Judgment to a Novel Host Response Diagnostic for Acute Respiratory Illness.Open Forum Infect Dis 8, no. 12 (December 2021): ofab564. https://doi.org/10.1093/ofid/ofab564.
Jaffe IS, Jaehne AK, Quackenbush E, Ko ER, Rivers EP, McClain MT, et al. Comparing the Diagnostic Accuracy of Clinician Judgment to a Novel Host Response Diagnostic for Acute Respiratory Illness. Open Forum Infect Dis. 2021 Dec;8(12):ofab564.
Jaffe, Ian S., et al. “Comparing the Diagnostic Accuracy of Clinician Judgment to a Novel Host Response Diagnostic for Acute Respiratory Illness.Open Forum Infect Dis, vol. 8, no. 12, Dec. 2021, p. ofab564. Pubmed, doi:10.1093/ofid/ofab564.
Jaffe IS, Jaehne AK, Quackenbush E, Ko ER, Rivers EP, McClain MT, Ginsburg GS, Woods CW, Tsalik EL. Comparing the Diagnostic Accuracy of Clinician Judgment to a Novel Host Response Diagnostic for Acute Respiratory Illness. Open Forum Infect Dis. 2021 Dec;8(12):ofab564.
Journal cover image

Published In

Open Forum Infect Dis

DOI

ISSN

2328-8957

Publication Date

December 2021

Volume

8

Issue

12

Start / End Page

ofab564

Location

United States

Related Subject Headings

  • 3207 Medical microbiology
  • 3202 Clinical sciences