Infective Endocarditis in the Emergency Department

A Systematic Review of the Challenges and Advancements in Early Diagnosis

Abstract

Background: Infective endocarditis (IE) remains an elusive diagnosis for emergency physicians due to its presentation with very non-specific symptoms. Prompt diagnosis of infective endocarditis is critical to earlier intervention and treatment outcomes. This review provides a detailed insight into the challenges of diagnosing infective endocarditis and uses an evidence-based approach to determine the most effective diagnostic strategies that will allow prompt diagnosis.

Methods and findings: A comprehensive literature search was conducted using PubMed, MEDLINE, Cochrane, and Google Scholar. The search terms included ‘Infective endocarditis’, ‘emergency department’, ‘diagnosis’, and ‘challenges’. The inclusion criteria were any articles that discussed the challenges and advancements in the early diagnosis of infective endocarditis. The risks of bias and methodological quality of the studies were assessed. The data from these articles were then collected, documented, and used to construct an evidentiary table. The search identified over 17,800 results. Out of those, 100 articles were selected based on the relevance of the title. 45 articles that fulfilled the inclusion criteria were then critically reviewed. 29 of the screened publications were case reports, 8 were reviews, 5 were cohort studies, and there was one publication each of a case control study, experimental study, and case series.

Conclusion: Prompt use of advanced imaging techniques and new diagnostic tools can add significantly to the diagnostic momentum. Key presentations and risk factors for infective endocarditis should be considered in clinical decision making to maximize outcomes for patients.