Clinical Reasoning of Infectious Diseases Physicians in the Decision to Perform or Forego TEEa
| TEE Not Obtained . | TEE Obtained . | ||
|---|---|---|---|
| Clinical Reasoning . | N = 89 . | Clinical Reasoning . | N = 28 . |
| Low clinical suspicion for endocarditis due to rapid clearance of blood cultures | 46 (52) | Valve abnormality on transthoracic echocardiogram | 6 (21) |
| Identification of a secondary focus requiring an extended treatment duration | 34 (38) | Persistent bacteremia of unclear etiology | 5 (18) |
| Contraindication to TEE | 10 (11) | Evidence of left-sided embolic disease | 4 (14) |
| Valves well visualized by transthoracic echocardiogram | 9 (10) | Intravascular prosthetic device | 4 (14) |
| Imminent death | 8 (9) | Primary team’s request without ID physician’s endorsement | 4 (14) |
| Patient declined | 4 (4) | Definitively exclude endocarditis to treat for a short duration | 3 (11) |
| Cardiology or primary service declined | 4 (4) | Other | 3 (11) |
| Removable source of infection | 3 (3) | ||
| Positive blood culture believed to be contaminant | 2 (2) | ||
| Other | 1 (1) | ||
| TEE Not Obtained . | TEE Obtained . | ||
|---|---|---|---|
| Clinical Reasoning . | N = 89 . | Clinical Reasoning . | N = 28 . |
| Low clinical suspicion for endocarditis due to rapid clearance of blood cultures | 46 (52) | Valve abnormality on transthoracic echocardiogram | 6 (21) |
| Identification of a secondary focus requiring an extended treatment duration | 34 (38) | Persistent bacteremia of unclear etiology | 5 (18) |
| Contraindication to TEE | 10 (11) | Evidence of left-sided embolic disease | 4 (14) |
| Valves well visualized by transthoracic echocardiogram | 9 (10) | Intravascular prosthetic device | 4 (14) |
| Imminent death | 8 (9) | Primary team’s request without ID physician’s endorsement | 4 (14) |
| Patient declined | 4 (4) | Definitively exclude endocarditis to treat for a short duration | 3 (11) |
| Cardiology or primary service declined | 4 (4) | Other | 3 (11) |
| Removable source of infection | 3 (3) | ||
| Positive blood culture believed to be contaminant | 2 (2) | ||
| Other | 1 (1) | ||
Abbreviations: ID, infectious diseases; TEE, transesophageal echocardiography.
aData presented as n (%).
Clinical Reasoning of Infectious Diseases Physicians in the Decision to Perform or Forego TEEa
| TEE Not Obtained . | TEE Obtained . | ||
|---|---|---|---|
| Clinical Reasoning . | N = 89 . | Clinical Reasoning . | N = 28 . |
| Low clinical suspicion for endocarditis due to rapid clearance of blood cultures | 46 (52) | Valve abnormality on transthoracic echocardiogram | 6 (21) |
| Identification of a secondary focus requiring an extended treatment duration | 34 (38) | Persistent bacteremia of unclear etiology | 5 (18) |
| Contraindication to TEE | 10 (11) | Evidence of left-sided embolic disease | 4 (14) |
| Valves well visualized by transthoracic echocardiogram | 9 (10) | Intravascular prosthetic device | 4 (14) |
| Imminent death | 8 (9) | Primary team’s request without ID physician’s endorsement | 4 (14) |
| Patient declined | 4 (4) | Definitively exclude endocarditis to treat for a short duration | 3 (11) |
| Cardiology or primary service declined | 4 (4) | Other | 3 (11) |
| Removable source of infection | 3 (3) | ||
| Positive blood culture believed to be contaminant | 2 (2) | ||
| Other | 1 (1) | ||
| TEE Not Obtained . | TEE Obtained . | ||
|---|---|---|---|
| Clinical Reasoning . | N = 89 . | Clinical Reasoning . | N = 28 . |
| Low clinical suspicion for endocarditis due to rapid clearance of blood cultures | 46 (52) | Valve abnormality on transthoracic echocardiogram | 6 (21) |
| Identification of a secondary focus requiring an extended treatment duration | 34 (38) | Persistent bacteremia of unclear etiology | 5 (18) |
| Contraindication to TEE | 10 (11) | Evidence of left-sided embolic disease | 4 (14) |
| Valves well visualized by transthoracic echocardiogram | 9 (10) | Intravascular prosthetic device | 4 (14) |
| Imminent death | 8 (9) | Primary team’s request without ID physician’s endorsement | 4 (14) |
| Patient declined | 4 (4) | Definitively exclude endocarditis to treat for a short duration | 3 (11) |
| Cardiology or primary service declined | 4 (4) | Other | 3 (11) |
| Removable source of infection | 3 (3) | ||
| Positive blood culture believed to be contaminant | 2 (2) | ||
| Other | 1 (1) | ||
Abbreviations: ID, infectious diseases; TEE, transesophageal echocardiography.
aData presented as n (%).
This PDF is available to Subscribers Only
View Article Abstract & Purchase OptionsFor full access to this pdf, sign in to an existing account, or purchase an annual subscription.
