Geographic Validation of the SADFUL Scores for Identifying Bacteremia in the Unscheduled Emergency Department Revisit Cohorts

Background The SADFUL score is developed to identify bacteremia in emergency department revisits (EDR), but its generalizability in various healthcare facilities and superiority over other scores remain unclear. This study aims to validate the SADFUL score in two hospitals with different levels of care. Method This retrospective cohort study included adult EDR patients from an academic medical center (Hospital A) and a rural regional hospital (Hospital B) between March 1, 2019, and December 31, 2022. The SADFUL, quick sequential organ failure assessment (qSOFA), systemic inflammatory response syndrome (SIRS) criteria, and shock index (SI) scores were compared using the area under the receiver operating characteristic curve (AUROC). Results The prevalence of bacteremia in the EDR cohort was 2.2% (120/5455). The SADFUL score’s performance was inconsistent across the two hospitals. In Hospital A, its AUROC of 0.64 was significantly higher than those of the SIRS criteria, qSOFA, and the SI. In contrast, in Hospital B, its numerically higher AUROC of 0.72 was not statistically superior to the other scores. The optimal cutoff also differed between the two settings (≥ 2 in Hospital A and ≥ 4 in Hospital B). Conclusion The SADFUL score demonstrated only modest accuracy and was not consistently superior to other commonly used clinical scoring systems. Overall, all evaluated tools exhibited limited utility in identifying bacteremia among EDR patients, highlighting the need for further research in this area.