Classify infective endocarditis as Definite, Possible, or Rejected using the 2023 Duke-ISCVID diagnostic criteria checklist.
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Here's exactly how this calculator classifies infective endocarditis. No black box — copy, audit, or adapt this algorithm freely.
Infective endocarditis (IE) is an infection of the endocardial surface of the heart, most commonly involving one or more heart valves. It is caused by bacteria (or less commonly fungi) entering the bloodstream and adhering to damaged or abnormal cardiac structures. IE can affect native valves, prosthetic valves, and implanted cardiac devices. Without treatment, IE is almost universally fatal. Even with appropriate therapy, in-hospital mortality remains 15–20%. The 2023 Duke-ISCVID criteria provide a standardized diagnostic framework used worldwide in both clinical practice and research.
The diagnostic criteria divide clinical findings into Major and Minor categories. Major criteria carry strong diagnostic weight — they include specific microbiologic findings (blood cultures with typical IE organisms, serology, or molecular diagnostics) and imaging evidence (echocardiography, cardiac CT, PET/CT showing vegetations, abscesses, or abnormal metabolic activity). The 2023 update also added intraoperative inspection as a major criterion. Minor criteria include predisposing conditions, fever, vascular phenomena (such as Janeway lesions or arterial emboli), immunologic phenomena (such as Osler nodes or Roth spots), and supportive microbiologic or imaging findings that fall short of major criteria.
While the Duke Criteria are the most widely used diagnostic framework for IE, they have recognized limitations:
The Duke Criteria are a standardized set of clinical, microbiologic, and imaging findings used to classify suspected cases of infective endocarditis (IE) as Definite, Possible, or Rejected. Originally published in 1994, they were modified in 2000 and most recently updated in 2023 by the International Society for Cardiovascular Infectious Diseases (ISCVID).
The 2023 update added cardiac CT and PET/CT as imaging criteria, introduced intraoperative inspection as a new major criterion, expanded the list of 'typical' IE-causing organisms, incorporated molecular diagnostics (PCR, metagenomic sequencing), removed requirements for blood culture timing and separate venipunctures, and clarified predisposing conditions such as transcatheter valves and CIEDs.
Definite IE requires 2 major criteria, or 1 major plus 3 minor criteria, or 5 minor criteria. Possible IE requires 1 major plus 1 minor criterion, or 3 minor criteria. If none of these combinations are met, the case is classified as Rejected. Note that Rejected also applies when a firm alternative diagnosis is established or when symptoms resolve rapidly with less than 4 days of antibiotics.
No. The Duke Criteria are a standardized framework to aid diagnosis, but they do not replace clinical judgment. The criteria cannot account for pathologic findings at surgery or autopsy, the consideration of alternative diagnoses, or the full clinical context. This calculator implements only the clinical criteria-counting algorithm.
Validation studies have shown that the 2023 Duke-ISCVID criteria have improved sensitivity (approximately 84%) compared to the 2000 modified Duke criteria (approximately 75%) without significant loss of specificity. The improvement is largely attributed to the addition of PET/CT imaging and expanded microbiologic criteria.