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Published on: November 7, 2018
Screening tools for bacteraemia in a selected population of febrile children
Hayri Levent Yilmaz1, Riza Dincer Yildizdas, Nazan Alparslan
1Medical Faculty of Cukurova University, Department of Paediatric Emergency Medicine, Adana, Turkey. hyilmaz@cu.edu.tr
Insights
The RISK score effectively predicts bacteremia in febrile children, reducing unnecessary blood cultures and treatments. This aids in managing pediatric infections and optimizing healthcare resource utilization.
Area of Science:
- Pediatric Infectious Diseases
- Clinical Microbiology
- Diagnostic Accuracy Studies
Background:
- Bacteremia is a serious concern in febrile children.
- Accurate prediction of bacteremia is crucial for appropriate management.
- Existing diagnostic tools may have limitations in identifying bacteremia in young children.
Purpose of the Study:
- To determine the incidence of bacteremia in febrile children in Turkey.
- To evaluate the predictive value of white blood cell (WBC) counts, manual differential counts, and the RISK score for bacteremia.
- To assess the clinical utility of the RISK score in reducing unnecessary interventions.
Main Methods:
- A prospective, observational study included 377 febrile children aged 3–36 months.
- Complete blood cell counts, manual differential counts, and blood cultures were performed.
- Statistical analysis included sensitivity, specificity, PPV, NPV, OR, AUC, and MDR for the RISK score.
Main Results:
- Bacteremia was present in 4.4% of children, with Streptococcus pneumoniae being the predominant pathogen.
- Yale Observation Scale scores, neutrophil and band percentages, band-neutrophil ratio, and absolute counts were significant predictors.
- A RISK score ≥ 2 demonstrated high sensitivity (93.8%) and negative predictive value (99.5%) for bacteremia.
Conclusions:
- The RISK score is a valuable tool for predicting bacteremia in febrile children aged 3–36 months.
- Implementing the RISK score can significantly reduce unnecessary blood cultures, antibiotic therapy, and hospitalizations.
- This approach aids in optimizing the management of febrile illnesses in pediatric populations.
Introduction:
This is a prospective, observational study. The aims of the study were to determine the rate of bacteraemia in febrile children in Turkey, and to evaluate the usefulness of white blood cell (WBC) count and manual differential counts of peripheral blood smears and a RISK score in predicting bacteraemia among these children.
Materials And Methods:
A total of 377 febrile children aged 3 to 36 months were included in the study. Complete blood cell (CBC) count, manual differential counts and blood cultures were performed in all patients. The main outcome measures used to evaluate the usefulness of the RISK score were sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), odds ratio (OR), posterior probability, areas under receiver operator characteristic curves (AUC) and miss-to-diagnosis ratio (MDR).
Results:
Among the patients, 4.4% had bacteraemia and the predominant pathogen was Streptococcus pneumoniae. The Yale Observation Scale scores, percentages of neutrophil and bands, band-neutrophil ratio, absolute neutrophil count and absolute band count were found to be statistically significant predictors of bacteraemia. When the RISK score was 2 or higher, sensitivity was 93.8%, false positive ratio 35.8%, PPV 10.6%, NPV 99.5%, OR 26.2 (95% CI, 3.4 to 200.8), MDR 0.066 and posterior probability value 10%.
Conclusions:
We conclude that determination of the RISK score will significantly decrease unnecessary blood culture sampling, antibiotherapy and hospitalisation among febrile patients aged 3 to 36 months without an identifiable focus of infection.