MDCalc

Shapiro Rule

Indicates if an ED patient qualifies for a blood culture.

Determines if clinician should consider obtaining a blood culture based on symptoms and clinical findings.

Age, years

Temperature

Suspect endocarditis

Indwelling vascular catheter

Chills

Vomiting

Hypotension (SBP <90 mm Hg)

White blood cell count >18,000 cell/mm3

Bands >5%

Platelets <150,000 cells/mm3

Creatinine >2.0 mg/dL

Result:

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Management
  • If 1 major criterion or ≥2 minor criteria are fulfilled, a blood culture is recommended by the Shapiro Rule.
  • However, no clinical rule should be used in isolation to determine patient management. Use your clinical judgment to determine if the results are applicable to your patient.
  • Follow local sepsis and blood culture clinical guidelines for treatment.