Low-Value Blood Culture Use in Adult Emergency Department Patients: A Scoping Review.

BACKGROUND

Blood cultures (BCs) are used in emergency departments (EDs) to investigate and manage suspected sepsis; however, their inappropriate use contributes to low-value care, providing limited clinical benefit while causing avoidable harm. Despite recommendations for more selective testing, low-value blood culture (LVBC) use persists, and there remains uncertainty on the definition, drivers, and impact of LVBCs.

OBJECTIVES

To map the existing literature on LVBCs in adult ED patients, including definitions of LVBCs, associated clinical contexts, contributing factors, consequences and related gaps in knowledge.

METHODS

Six databases were searched from inception to June 30, 2025. Studies involving adult populations and addressing LVBC use in EDs were included. Data were charted independently by two reviewers. Risk of bias was assessed using JBI critical appraisal tools.

RESULTS

Of 1453 records screened, 18 studies were included in this scoping review. None defined LVBCs, although five themes characterising LVBCs emerged: limited impact on patient management, non-adherence to guidelines, failure to meet predictive tool thresholds, protocol-driven ordering, and BCs deemed unnecessary by clinicians. Reported prevalence of LVBCs ranged from 19% to 69%. The most referenced LVBC driver was pressure to comply with quality measures. Reported consequences of LVBCs included unnecessary treatment, investigation and prolonged stay due to false positive results. Patient-centred outcomes were rarely reported, and formal economic evaluations were lacking.

CONCLUSION

LVBCs are prevalent among adult ED patients yet inconsistently defined. Addressing the issue will require standardised criteria, interventions targeting root causes, and research focused on patient-centred and economic consequences to optimise BC ordering practices.