Discussion: Infective endocarditis(IE) has significant morbidity and one-year mortality of 20-40% which makes timely diagnosis vital. Modified Duke criteria employs pathologic, clinical and imaging modalities to stratify patients as definite, possible or rejected IE. Given the poor prognosis without treatment, the sensitivity and specificity (each around 80%) of the modified Duke criteria are suboptimal. Echocardiography is the primary imaging modality used for diagnosis, however transesophageal echocardiography(TEE) can miss the diagnosis in up to 30% of cases. Clinicians should consider alternate imaging modalities such as CT if TEE is unrevealing in highly suspicious cases.
Conclusions: Infective endocarditis although uncommon is associated with significant morbidity and mortality (in-hospital 14-22%). Early and accurate diagnosis is essential to prevent negative outcomes. The modified Duke criteria is a validated diagnostic tool, however it must be used along with clinical judgement and in context of pre-test probability. Our case signifies that hospitalists should have a low threshold for initiating therapy if the clinical presentation suggests IE even in the absence of Duke criteria.
To cite this abstract:Fiazuddin, F; Ladak, F; Ratcliffe, T . WHEN IS THE DUKE CRITERIA NOT ENOUGH?. Abstract published at Hospital Medicine 2017, May 1-4, 2017; Las Vegas, Nev. Abstract 442. Journal of Hospital Medicine. 2017; 12 (suppl 2). https://www.shmabstracts.com/abstract/when-is-the-duke-criteria-not-enough/. Accessed January 28, 2020.