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Predicting serious bacterial infection in young children with fever without apparent source
S E Bleeker1, K G Moons, G Derksen-Lubsen
1Department of Paediatrics, Sophia Children's Hospital, University Hospital Rotterdam, The Netherlands. bleeker@alkg.azr.nl
Insights
A clinical rule can accurately predict serious bacterial infections in febrile children without a source. Key predictors include fever duration, vomiting, and lab results like white blood cell count, aiding precise risk stratification.
Area of Science:
- Pediatrics
- Infectious Diseases
- Clinical Decision Rules
Background:
- Fever without a source is common in children, posing diagnostic challenges.
- Identifying serious bacterial infections (SBIs) early is crucial for timely treatment and preventing complications.
Purpose of the Study:
- To develop and validate a clinical rule for predicting SBIs in children aged 1-36 months presenting with fever without a source.
- To stratify risk for SBIs using a combination of clinical and laboratory predictors.
Main Methods:
- Retrospective analysis of 231 children (aged 1-36 months) with fever without a source.
- Multivariate logistic regression and ROC curve analysis to identify independent predictors of SBI.
- Development of a risk stratification model.
Main Results:
- Twenty-five percent of patients had an SBI.
- Clinical predictors (fever duration, poor micturition, vomiting, age, temperature extremes, chest retractions, poor circulation) showed moderate predictive value (ROC area: 0.75).
- Laboratory predictors (WBC count, CRP, urinalysis WBCs) demonstrated higher predictive value (ROC area: 0.83).
Conclusions:
- A clinical rule incorporating specific symptoms, signs, and laboratory tests can more precisely estimate the probability of SBI in children with fever without a source.
- This tool aids in better risk stratification and management decisions.
Unlabelled:
The aim of this study was to design a clinical rule to predict the presence of a serious bacterial infection in children with fever without apparent source. Information was collected from the records of children aged 1-36 mo who attended the paediatric emergency department because of fever without source (temperature > or = 38 degrees C and no apparent source found after evaluation by a general practitioner or history by a paediatrician). Serious bacterial infection included bacterial meningitis, sepsis, bacteraemia, pneumonia, urinary tract infection, bacterial gastroenteritis, osteomyelitis and ethmoiditis. Using multivariate logistic regression and the area under the receiver operating characteristic curve (ROC area), the diagnostic value of predictors for serious bacterial infection was judged, resulting in a risk stratification. Twenty-five percent of the 231 patients enrolled in the study (mean age 1.1 y) had a serious bacterial infection. Independent predictors from history and examination included duration of fever, poor micturition, vomiting, age, temperature < 36.7 degrees C or > or = 40 degrees C at examination, chest-wall retractions and poor peripheral circulation (ROC area: 0.75). Independent predictors from laboratory tests were white blood cell count, serum C-reactive protein and the presence of >70 white blood cells in urinalysis (ROC area: 0.83). The risk stratification for serious bacterial infection ranged from 6% to 92%.
Conclusion:
The probability of a serious bacterial infection in the individual patient with fever without source can be estimated more precisely by using a limited number of symptoms, signs and laboratory tests.