Infective endocarditis (IE) is one of the most serious medical complications associated with intravenous drug use (IDU), with significant morbidity and mortality occurring in unrecognized cases. Presenting clinical features associated with IE have been difficult to define. Since fever occurs in nearly 98% of cases of IE in IDUs, current practice is to hospitalize all febrile IDUs for further evaluation. This represents a significant financial cost to hospitals, as nearly 90% of these patients are ultimately found not to have IE. The overall goal of this study is to develop and implement a safe and cost-effective Emergency Department (ED)- based algorithm for the evaluation of febrile IDUs at risk for IE. We hypothesize that, by taking advantage of recent developments which combine findings from advanced diagnostic testing (including echocardiography) and clinical assessment, this algorithm will enable ED physicians to more quickly and reliably stratify patients at risk for IE. We further hypothesize that disposition of the subset of patients in whom IE has been ruled-out, to less resource-intensive settings will reduce the number of hospitalizations without increasing adverse events, thus promoting more efficient use of clinical resources. In phase 1 (ongoing), patients who meet inclusion criteria are admitted to the General Clinical Research Center for a minimum of 48 hours for further evaluation and treatment. Findings from standard clinical, laboratory, and imaging tests, as well as a novel laboratory based diagnostic tool (PCR), will be utilized to design alternative diagnostic strategies, which will allow ED physicians to predict with increased specificity which febrile IDUs are likely to either have IE and/or develop complications that require hospitalization. Data will then be used to evaluate the relative costs of each diagnostic strategy, taking into account costs at both the individual and societal level. Calculation of potential' cost savings is in the range of several hundred million dollars. The findings and decision algorithms developed here will ultimately be employed to develop a larger study (phase 2), intended to validate the clinical efficacy of our new guidelines, and determine the true cost differential associated with a change in clinical practice.

Agency
National Institute of Health (NIH)
Institute
National Center for Research Resources (NCRR)
Type
General Clinical Research Centers Program (M01)
Project #
2M01RR000052-39
Application #
6412314
Study Section
Special Emphasis Panel (ZRR1)
Project Start
1975-10-01
Project End
2004-11-30
Budget Start
Budget End
Support Year
39
Fiscal Year
2000
Total Cost
Indirect Cost
Name
Johns Hopkins University
Department
Type
DUNS #
045911138
City
Baltimore
State
MD
Country
United States
Zip Code
21218
Robert Braši?, James; Mari, Zoltan; Lerner, Alicja et al. (2018) Remission of Gilles de la Tourette Syndrome after Heat-Induced Dehydration. Int J Phys Med Rehabil 6:
Altman, Matthew C; Whalen, Elizabeth; Togias, Alkis et al. (2018) Allergen-induced activation of natural killer cells represents an early-life immune response in the development of allergic asthma. J Allergy Clin Immunol 142:1856-1866
AIDS-defining Cancer Project Working Group of IeDEA, COHERE in EuroCoord (2018) Non-Hodgkin lymphoma risk in adults living with HIV across five continents. AIDS 32:2777-2786
Juraschek, Stephen P; Miller 3rd, Edgar R; Appel, Lawrence J (2018) Orthostatic Hypotension and Symptoms in the AASK Trial. Am J Hypertens 31:665-671
Elion, Richard A; Althoff, Keri N; Zhang, Jinbing et al. (2018) Recent Abacavir Use Increases Risk of Type 1 and Type 2 Myocardial Infarctions Among Adults With HIV. J Acquir Immune Defic Syndr 78:62-72
Al-Sofiani, Mohammed E; Yanek, Lisa R; Faraday, Nauder et al. (2018) Diabetes and Platelet Response to Low-Dose Aspirin. J Clin Endocrinol Metab 103:4599-4608
Grover, Surbhi; Desir, Fidel; Jing, Yuezhou et al. (2018) Reduced Cancer Survival Among Adults With HIV and AIDS-Defining Illnesses Despite No Difference in Cancer Stage at Diagnosis. J Acquir Immune Defic Syndr 79:421-429
Grams, Morgan E; Sang, Yingying; Ballew, Shoshana H et al. (2018) Predicting timing of clinical outcomes in patients with chronic kidney disease and severely decreased glomerular filtration rate. Kidney Int 93:1442-1451
Yanik, Elizabeth L; Hernández-Ramírez, Raúl U; Qin, Li et al. (2018) Brief Report: Cutaneous Melanoma Risk Among People With HIV in the United States and Canada. J Acquir Immune Defic Syndr 78:499-504
Aboud, Katherine S; Barquero, Laura A; Cutting, Laurie E (2018) Prefrontal mediation of the reading network predicts intervention response in dyslexia. Cortex 101:96-106

Showing the most recent 10 out of 1014 publications