Emergency Medicine · Infectious Disease
Shapiro Rule for Blood Cultures calculator
Enter the published formula inputs below to calculate and interpret this score.
Clinical inputs
Allowed range: 86–113 °F
Major if above 39.5 °C (103.0 °F). Minor if 38.3 through 39.4 °C (101 through 102.9 °F). 39.5 °C is neither.
Allowed range: 18–120 years
Allowed range: 40–250 mmHg
Allowed range: 0–100 %
Minor if above 80%.
Allowed range: 0–100 ×10⁹/L
Minor if above 18 ×10³/µL. The ×10⁹/L entry uses the same number.
Allowed range: 0–100 %
Minor if above 5%.
Allowed range: 0–1000 ×10⁹/L
Minor if below 150 ×10³/µL. The ×10⁹/L entry uses the same number.
Allowed range: 0–20 mg/dL
Minor if above 2.0 mg/dL. The abstract does not print a molar unit. The µmol/L entry is divided by 88.4.
Result
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Clinical inputs
- Temperature (°C)Accepted range: 30 to 45
- Age (years)Accepted range: 18 to 120
- Systolic blood pressure (mmHg)Accepted range: 40 to 250
- Neutrophil percent (%)Accepted range: 0 to 100
- White blood cell count (×10³/µL)Accepted range: 0 to 100
- Band percent (%)Accepted range: 0 to 100
- Platelet count (×10³/µL)Accepted range: 0 to 1000
- Creatinine (mg/dL)Accepted range: 0 to 20
- Indwelling vascular catheter
- Suspected endocarditis
- Chills
- Vomiting
Primary source
Shapiro NI, Wolfe RE, Wright SB, Moore R, Bates DW. Who needs a blood culture? A prospectively derived and validated prediction rule. J Emerg Med. DOI: 10.1016/j.jemermed.2008.04.001. PMID: 18486413. The Elsevier PDF returned HTTP 403. The complete rule is printed in the authors' abstract. Major criteria: temperature above 39.5 °C (103.0 °F), indwelling vascular catheter, or clinical suspicion of endocarditis. Minor criteria: temperature 38.3–39.4 °C (101–102.9 °F), age above 65 years, chills, vomiting, systolic blood pressure below 90 mm Hg, neutrophil percent above 80, white blood cell count above 18 ×10³/µL, bands above 5%, platelets below 150 ×10³/µL, and creatinine above 2.0 mg/dL. A culture is indicated for at least one major criterion or at least two minor criteria. Otherwise the patient is low risk and cultures may be omitted. Temperature 39.5 °C meets neither the major nor the minor temperature criterion. Derivation sensitivity was 98%, with 4 positive cultures among low-risk patients (0.6%). Validation sensitivity was 97%, with 3 positive cultures among low-risk patients (0.9%). Open reprints that change these cuts, including temperature at or above 39.4 °C, were not used. The abstract does not print a molar creatinine unit; the alternate unit uses 88.4 so 176.8 µmol/L equals 2.0 mg/dL. (2008)
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