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The case of NOVA and DENOVA scores for Enterococcus faecalis bacteremia - Brief Communication","","NOVA and DENOVA scores were designed to support endocarditis risk assessment in Enterococcus faecalis bacteremia, but several criteria may be interpreted differently. Inter-rater reliability and feasibility were evaluated by having 32 physicians from four specialties independently score eight patient records. Each score was applied eight times per case. Inter-rater reliability was assessed using Krippendorff’s alpha and Fleiss’ kappa; completion time was also recorded.",{"@graph":69,"@context":122},[70,84,105],{"@type":71,"itemListElement":72},"BreadcrumbList",[73,77,79,82],{"item":74,"name":75,"@type":76,"position":8},"https://docshare.wps.com","Home","ListItem",{"item":78,"name":9,"@type":76,"position":14},"https://docshare.wps.com/document/",{"item":80,"name":35,"@type":76,"position":81},"https://docshare.wps.com/document/healthcare/",3,{"item":83,"name":65,"@type":76,"position":19},"https://docshare.wps.com/document/endocarditis-risk-stratification-with-scores-what-about-reproducibility-the-case-of-nova-and-denova-scores-for-enterococcus-faecalis-bacteremia-brief-communication/415652/",{"url":83,"name":65,"@type":85,"image":86,"author":91,"headline":65,"publisher":94,"fileFormat":97,"inLanguage":63,"description":67,"dateModified":98,"datePublished":99,"encodingFormat":97,"isAccessibleForFree":100,"interactionStatistic":101},"DigitalDocument",{"url":87,"@type":88,"width":89,"height":90},"https://docshare.wps.com/thumbnails/endocarditis-risk-stratification-with-scores-what-about-reproducibility-the-case-of-nova-and-denova-scores-for-enterococcus-faecalis-bacteremia-brief-communication/415652.png","ImageObject",300,407,{"name":92,"@type":93},"Fahsai","Person",{"url":74,"name":95,"@type":96},"DocShare","Organization","application/pdf","2026-11-01","2026-09-28",true,{"@type":102,"interactionType":103,"userInteractionCount":44},"InteractionCounter",{"@type":104},"ViewAction",{"@type":106,"mainEntity":107},"FAQPage",[108,114,118],{"name":109,"@type":110,"acceptedAnswer":111},"What was the main objective of the study?","Question",{"text":112,"@type":113},"To evaluate the inter-rater reproducibility and feasibility of the NOVA and DENOVA scores for endocarditis risk assessment in Enterococcus faecalis bacteremia.","Answer",{"name":115,"@type":110,"acceptedAnswer":116},"How were NOVA and DENOVA scores evaluated for reproducibility?",{"text":117,"@type":113},"Thirty-two clinicians from four specialties independently assessed eight patient records, applying NOVA and DENOVA scores multiple times per case. Reliability was measured using Krippendorff’s alpha and agreement using Fleiss’ Kappa.",{"name":119,"@type":110,"acceptedAnswer":120},"What did the results show about score reliability?",{"text":121,"@type":113},"No record received identical scores from all raters; NOVA showed low inter-rater reliability while DENOVA showed moderate reliability. Agreement was higher for extreme values but dropped substantially for intermediate values.","https://schema.org",{"og:url":83,"og:type":124,"og:title":65,"og:site_name":95,"og:description":67},"article",{"robots":126,"canonical":83},"index,follow",{"doc_id":128,"site_id":62},415652,1790767903,{"code":4,"msg":5,"data":131},{"doc_id":128,"user_id":132,"nickname":92,"user_avatar":133,"doc_module":4,"category_id":34,"category_name":35,"doc_title":65,"doc_description":67,"doc_content":134,"file_id":135,"file_url":136,"file_type":137,"file_size":138,"view_count":44,"is_deleted":4,"is_public":8,"is_downloadable":8,"audit_status":8,"page_count":81,"language":139,"language_code":63,"site_id":62,"html_lang":63,"table_of_contents":140,"faqs":141,"seo_title":142,"seo_description":67,"update_tm":143,"read_time":39,"preview_page_count":4},549768702563,"https://ap-avatar.wpscdn.com/avatar/8000c4aa63b76e948b?x-image-process=image/resize,m_fixed,w_180,h_180&k=1786536092046926083","Braz J Infect Dis. 30 (2026) 104605  \nContents lists available at ScienceDirect  \nBrazilian Journal of Infectious Diseases  \njournal [homepage:](homepage: www.elsevier.com/locate/bjid)[ www.elsevier.com/locate/bjid](homepage: www.elsevier.com/locate/bjid)  \n| Brief Communication\u003Cbr>Endocarditis risk stratification with scores: what about reproducibility? The case of NOVA and DENOVA scores for Enterococcus faecalis bacteremia |  |  | |\n| --- | --- | --- | --- |\n| Pierre Danneelsa,* , Floris Chabrunb, Lucia Grandi`ere-P´erez c , Ali Tour´e d, Vincent Dub´ee a \u003Cbr>a University Hospital, Infectious Diseases and Tropical Medicine Department, Angers, France b University Hospital, Biochemistry and Molecular Biology Laboratory, Angers, France c General Hospital, Infectious Diseases and Tropical Medicine Department, Le Mans, France d Pole Sant´e Sud, Emergency Department, Le Mans, France |  |  |  |\n| A R T I C L E I N F O |  | A B S T R A C T |  |\n| Editor: Dr. Luciano Goldani. |  | Objectives: NOVA and DENOVA scores were developed to guide endocarditis risk assessment in Enterococcus faecalis Bacteremia (EfB), but some of their criteria may be open to interpretation. We aimed to evaluate their inter-rater reliability and feasibility.\u003Cbr>Methods: Thirty-two physicians from four specialties involved in the management of endocarditis independently evaluated eight EfB patient records using the NOVA and DENOVA scores. Each score was applied eight times per case. Inter-rater reliability was measured with Krippendorff’s alpha, and agreement with Fleiss’ Kappa. Completion time was also recorded.\u003Cbr>Results: No record received identical scores from all raters. NOVA showed low inter-rater reliability (α = 0.37), while DENOVA reached moderate levels (α = 0.49). High agreement was found for extreme score values, but agreement dropped markedly for intermediate values. Among score items, Auscultation of murmur (A) and Valve disease (V) had the highest reliability (α > 0.8), while Duration of symptoms (D) and Origin of infection (O) had the lowest (α \u003C 0.2). Completion times were similar between NOVA and DENOVA but varied by specialty. Conclusion: The reproducibility of these scores is limited, especially near critical thresholds, highlighting the need to complement scoring tools with clinical judgment in EfB. |  |\n| Keywords:\u003Cbr>E. faecalis Endocarditis Bacteremia Reproducibility |  |  |  |\n\nIntroduction  \nGram-positive cocci bacteremia is frequently associated with endocarditis: 5 %‒20 % of cases for Staphylococcus aureus; 8 %‒26 % for Enterococcus faecalis; and a significant variability ranging from 1 % to 48 % depending on the Streptococcus spp. species.1,2 Hence, there is a need for reliable and simple tools to rapidly identify patients with bacteremia at higher risk of endocarditis.  \nIn their narrative review, Rasmussen et al. present an algorithm based on an endocarditis risk stratification system for investigating patients with cocci gram-positive bacteremia.1 This risk assessment uses scores developed to help clinicians target patients requiring echocardiography: the VIRSTA, PREDICT and POSITIVE scores for S. aureus; NOVA and DENOVA scores for E. faecalis; or the HANDOC score for non-β-hemolytic Streptococcus spp.3,4 These scores have been designed and optimized to maximize their diagnostic performance. In the case of E. faecalis bacteremia, the DENOVA score shows a better performance  \n(Sensitivity 95 %‒100 % and Specificity 84 %‒85 % for a threshold ≥ 3) than the NOVA score (Sensitivity 97 %‒99 % and Specificity 23 %‒56 % for a threshold ≥ 4).4,5  \nHowever, these scores were established from data collected retrospectively and some of their criteria may be open to interpretation. Reproducibility and feasibility studies, which have not yet been carried out, are therefore needed to address these limitations.  \nThe objective of our study is therefore to investigate the reproducibility and feasibility of the NOVA and DENOVA scores.  \nMethods ","cbCaibqjjvK6RN2U","https://ap.wps.com/l/cbCaibqjjvK6RN2U","pdf",685998,"English","# Introduction\n## Need for reliable endocarditis risk tools\n## Background on existing scoring systems\n# Objectives\n# Methods\n## Definitions of NOVA and DENOVA criteria\n## Score feasibility and reproducibility","[{\"question\":\"What was the main objective of the study?\",\"answer\":\"To evaluate the inter-rater reproducibility and feasibility of the NOVA and DENOVA scores for endocarditis risk assessment in Enterococcus faecalis bacteremia.\"},{\"question\":\"How were NOVA and DENOVA scores evaluated for reproducibility?\",\"answer\":\"Thirty-two clinicians from four specialties independently assessed eight patient records, applying NOVA and DENOVA scores multiple times per case. Reliability was measured using Krippendorff’s alpha and agreement using Fleiss’ Kappa.\"},{\"question\":\"What did the results show about score reliability?\",\"answer\":\"No record received identical scores from all raters; NOVA showed low inter-rater reliability while DENOVA showed moderate reliability. Agreement was higher for extreme values but dropped substantially for intermediate values.\"}]","Endocarditis risk stratification with scores: what about reproducibility? The case of NOVA and DENOVA scores for Enterococcus faecalis bacteremia - Brief Communication | PDF",1790602309]