Clinical prediction model to aid emergency doctors managing febrile children at risk of serious bacterial infections: diagnostic study

Abstract

Objective To derive, cross validate, and externally validate a clinical prediction model that assesses the risks of different serious bacterial infections in children with fever at the emergency department.Design Prospective observational diagnostic study.Setting Three paediatric emergency care units: two in the Netherlands and one in the United Kingdom.Participants Children with fever, aged 1 month to 15 years, at three paediatric emergency care units: Rotterdam (n=1750) and the Hague (n=967), the Netherlands, and Coventry (n=487), United Kingdom. A prediction model was constructed using multivariable polytomous logistic regression analysis and included the predefined predictor variables age, duration of fever, tachycardia, temperature, tachypnoea, ill appearance, chest wall retractions, prolonged capillary refill time (>3 seconds), oxygen saturation <94%, and C reactive protein.Main outcome measures Pneumonia, other serious bacterial infections (SBIs, including septicaemia/meningitis, urinary tract infections, and others), and no SBIs.Results Oxygen saturation <94% and presence of tachypnoea were important predictors of pneumonia. A raised C reactive protein level predicted the presence of both pneumonia and other SBIs, whereas chest wall retractions and oxygen saturation <94% were useful to rule out the presence of other SBIs. Discriminative ability (C statistic) to predict pneumonia was 0.81 (95% confidence interval 0.73 to 0.88); for other SBIs this was even better: 0.86 (0.79 to 0.92). Risk thresholds of 10% or more were useful to identify children with serious bacterial infections; risk thresholds less than 2.5% were useful to rule out the presence of serious bacterial infections. External validation showed good discrimination for the prediction of pneumonia (0.81, 0.69 to 0.93); discriminative ability for the prediction of other SBIs was lower (0.69, 0.53 to 0.86).Conclusion A validated prediction model, including clinical signs, symptoms, and C reactive protein level, was useful for estimating the likelihood of pneumonia and other SBIs in children with fever, such as septicaemia/meningitis and urinary tract infections.

Досвід Використання Препарату Нурофєн® Для Дітей Форте В Педіатричній Практиці

“…E-mail: Pr-Marushko@yandex.ru © Марушко Ю.В., Гищак Т.В., Мика М.Ю., Тодика Ю.І., 2016 © «Здоров 'я дитини», 2016 © Заславський О.Ю., 2016 випадків підвищення температури тіла в дитини батьки купірують жарознижуючими препаратами самостійно, без залучення медичної допомоги [12]. У Великобританії від 10 до 20 % звернень до відді-лення дитячої невідкладної допомоги зумовлені ли-хоманкою із гіпертермічним синдромом [15].…”

“…E-mail: Pr-Marushko@yandex.ru © Марушко Ю.В., Гищак Т.В., Мика М.Ю., Тодика Ю.І., 2016 © «Здоров 'я дитини», 2016 © Заславський О.Ю., 2016 випадків підвищення температури тіла в дитини батьки купірують жарознижуючими препаратами самостійно, без залучення медичної допомоги [12]. У Великобританії від 10 до 20 % звернень до відді-лення дитячої невідкладної допомоги зумовлені ли-хоманкою із гіпертермічним синдромом [15].Перше питання, з яким стикається практикую-чий лікар-педіатр при обстеженні дитини зі скар-гами батьків на підвищення температури тіла, -це інтерпретація термометрії. Цікаво, що чутливість та специфічність батьківської скарги «на дотик дитина горить» становить до 75-85 % щодо об'єктивного підтвердження лихоманки.…”

Comparison of the Eosinophil Count to C –reactive protein, Leukocyte Count, and Neutrophil Count for the detection of bacterial infection in ill-appearing children with fever admitted to the Emergency Department

“…C-reactive protein (CRP) and the leukocyte and neutrophil counts are the acute-phase reactants used most widely in children admitted to the emergency department with a high fever. (1)(2)(3) In the last 20 years, procalcitonin has been identified as a promising bacterial infection marker in children with fever. Also, CD 15s as a neutrophil surface molecule was reported a potentially valuable biomarker in infants with severe bacterial infection.…”

Blood Culture and Bacteremia Predictors in Infants Less Than One Year of Age With Fever Without Source (Fws)

“…1,2,3 Infants eventually diagnosed with SBI can appear well and have nonspecific signs. 4 Several management protocols have been designed to evaluate these children to identify those at high risk of developing SBI. The traditional approach to febrile young infants involves performing a white blood cell count (WBC) and blood and urine cultures, administering antibiotics, and admitting them to hospital.…”