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Validating and updating a prediction rule for serious bacterial infection in patients with fever without source
S E Bleeker1, G Derksen-Lubsen, D E Grobbee
1Erasmus Medical Center - Sophia, Department of Paediatrics, Rotterdam, The Netherlands.
Insights
This study updated a prediction rule for serious bacterial infections in children with fever. The enhanced rule, using clinical and lab data, improves prediction accuracy for early diagnosis and treatment.
Area of Science:
- Pediatric infectious diseases
- Clinical prediction modeling
- Epidemiology of childhood infections
Background:
- Fever without apparent source is common in children.
- Accurate prediction of serious bacterial infections (SBIs) is crucial for timely management.
- Previous prediction rules require external validation and updating.
Purpose of the Study:
- To externally validate a prior prediction rule for SBIs in febrile children.
- To update and improve the prediction rule's accuracy and generalizability.
- To identify key clinical and laboratory predictors of SBIs.
Main Methods:
- Prospective enrollment of children aged 1-36 months with fever without source.
- External validation of an existing prediction rule.
- Updating the rule using multivariable logistic regression with combined historical and new patient data.
Main Results:
- The original rule showed insufficient generalizability in the new cohort.
- Updated rule identified fever duration, vomiting, ill appearance, retractions, and poor circulation as key predictors (ROC 0.69).
- Adding serum white blood cell count, C-reactive protein, and urinalysis findings significantly improved prediction (ROC 0.83).
Conclusions:
- An updated prediction rule for SBIs in febrile children was developed.
- The clinical score serves as an initial screening tool.
- Laboratory tests refine individual risk assessment for SBIs.
Aim:
To externally validate and update a previously developed rule for predicting the presence of serious bacterial infections in children with fever without apparent source.
Methods:
Patients, 1-36 mo, presenting with fever without source, were prospectively enrolled. Serious bacterial infection included bacterial meningitis, sepsis, bacteraemia, pneumonia, urinary tract infection, bacterial gastroenteritis, osteomyelitis/ethmoiditis. The generalizability of the original rule was determined. Subsequently, the prediction rule was updated using all available data of the patients with fever without source (1996-1998 and 2000-2001, n = 381) using multivariable logistic regression.
Results:
the generalizability of the rule appeared insufficient in the new patients (n = 150). In the updated rule, independent predictors from history and examination were duration of fever, vomiting, ill clinical appearance, chest-wall retractions and poor peripheral circulation (ROC area (95%CI): 0.69 (0.63-0.75)). Additional independent predictors from laboratory were serum white blood cell count and C-reactive protein, and in urinalysis > or = 70 white bloods (ROC area (95%CI): 0.83 (0.78-0.88).
Conclusions:
A previously developed prediction rule for predicting the presence of serious bacterial infection in children with fever without apparent source was updated. Its clinical score can be used as a first screening tool. Additional laboratory testing may specify the individual risk estimate (range: 4-54%) further.
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01:30Acute Pharyngitis
Acute pharyngitis is the inflammation of the back of the throat (pharynx), commonly resulting in a sore throat. It is a frequently encountered condition that prompts individuals to seek medical advice.
Classification
Acute pharyngitis can be categorized based on its underlying cause: