🦠 Infective Endocarditis Diagnosis (Modified Duke)
UseManagement follows current guidelines and local protocols; this page gives no management recommendation.
SourceFowler VG, et al. 2023 Duke-ISCVID criteria. Clin Infect Dis 2023.
This-shift next steps
After scoring: open the scene pack, peer scores, and the matching pathway. Local reference — no HIS write.
Paste the link in Slack, Teams, X, or LinkedIn — the preview image comes from this page’s Open Graph card.
Methodology · worked example, guidelines & full notes
A negative transthoracic echo with high clinical suspicion warrants a transesophageal echo before rejecting the diagnosis (original synthesis · not guideline verbatim).
When to use
Management follows current guidelines and local protocols; this page gives no management recommendation.
How it works
Definite = 2 major, or 1 major + 3 minor, or 5 minor; possible = 1 major + 1 minor, or 3 minor; otherwise rejected. Major = typical microbiology or imaging evidence; minor = predisposition, fever, vascular/immunologic phenomena, supporting microbiology.
Key points
- A negative transthoracic echo with high clinical suspicion warrants a transesophageal echo before rejecting the diagnosis (original synthesis · not guideline verbatim).
- The 2023 Duke-ISCVID revision adds cardiac CT, intraoperative findings, and PET/CT and broadens predisposition to CIED/TAVR/prior IE.
- Pathologic criteria (organism in vegetation/valve tissue) confirm directly and override the clinical count.
References
Worked calculation
The values below come from this tool's own example placeholders and are computed server-side with the formula shown on this page, so the arithmetic can be checked quickly. It demonstrates how to substitute values only — it is not clinical advice and not a real case.
| Major · microbiology (2 sets of blood cultures with typical IE organisms / persistently positive / single C. burnetii or IgG antibody > 1:800) | No |
|---|---|
| Major · imaging (echo/cardiac CT showing vegetation/abscess/perivalvular involvement/new prosthetic dehiscence; or surgical/PET evidence) | No |
| Minor · predisposition (underlying heart disease/prosthetic valve/CIED/IV drug use/prior IE) | No |
| Minor · fever ≥ 38℃ | No |
| Minor · vascular phenomena (arterial embolism/septic pulmonary infarction/mycotic aneurysm/intracranial hemorrhage/Janeway lesions) | No |
| Minor · immunologic phenomena (glomerulonephritis/Osler nodes/Roth spots/rheumatoid factor) | No |
| Minor · microbiologic evidence (not meeting a major criterion) | No |
→Duke determinationRejected (needs exclusion/reassessment)
- Count：Major criteria 0, minor criteria 0 → Rejected (needs exclusion/reassessment)
- Decision rule：Definite = 2 major or 1 major + 3 minor or 5 minor; possible = 1 major + 1 minor or 3 minor; otherwise rejected
- Management direction：Assess other causes of fever/bacteremia
| Major · microbiology (2 sets of blood cultures with typical IE organisms / persistently positive / single C. burnetii or IgG antibody > 1:800) | Met |
|---|---|
| Major · imaging (echo/cardiac CT showing vegetation/abscess/perivalvular involvement/new prosthetic dehiscence; or surgical/PET evidence) | Met |
| Minor · predisposition (underlying heart disease/prosthetic valve/CIED/IV drug use/prior IE) | Met |
| Minor · fever ≥ 38℃ | Met |
| Minor · vascular phenomena (arterial embolism/septic pulmonary infarction/mycotic aneurysm/intracranial hemorrhage/Janeway lesions) | Met |
| Minor · immunologic phenomena (glomerulonephritis/Osler nodes/Roth spots/rheumatoid factor) | Met |
| Minor · microbiologic evidence (not meeting a major criterion) | Met |
→Duke determinationDefinite IE (clinical criteria)
- Count：Major criteria 2, minor criteria 5 → Definite IE (clinical criteria)
- Decision rule：Definite = 2 major or 1 major + 3 minor or 5 minor; possible = 1 major + 1 minor or 3 minor; otherwise rejected
- Management direction：Management follows current guidelines and local protocols; this page gives no management recommendation.
Verification & sources · governance
FAQ
Frequently asked questions
- What are the limits and cautions when using Infective Endocarditis Diagnosis (Modified Duke)?
- For licensed clinicians and clinical researchers. Interpret results with history, investigations and local protocols; not a diagnosis or prescription, and not a substitute for multidisciplinary decision-making or local guidelines.
- Does Infective Endocarditis Diagnosis (Modified Duke) upload patient data? Where is it calculated?
- Calculation runs locally in the browser; inputs and results are not uploaded. For licensed clinicians only; interpret with history, investigations and local protocols — not a diagnosis or prescription.