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Identifying severe bacterial infection in children with fever without source
Annick Galetto-Lacour1, Alain Gervaix
1Division of Pediatric Emergency Medicine, Geneva University Hospitals and University of Geneva, 1211 Geneva 14, Switzerland. annick.galetto@hcuge.ch
Expert Review of Anti-Infective Therapy
|November 16, 2010
Summary
Identifying severe bacterial infections in young children with fever is challenging. A new risk index combining procalcitonin, C-reactive protein, and urinary dipstick shows promise for accurate diagnosis.
Area of Science:
- Pediatrics
- Infectious Diseases
- Clinical Diagnostics
Background:
- Differentiating severe bacterial from viral infections in febrile children without a source is a persistent clinical challenge.
- Current guidelines often suggest white blood cell count, but C-reactive protein and procalcitonin demonstrate superior diagnostic characteristics.
- Existing clinical decision rules are often too complex for practical implementation.
Purpose of the Study:
- To evaluate the effectiveness of a novel risk index score in identifying severe bacterial infections in young children.
- To assess the diagnostic accuracy of combining procalcitonin, C-reactive protein, and urinary dipstick tests.
Main Methods:
- A review of existing literature on diagnostic markers for fever without source in children.
- Analysis of a recently proposed simple risk index score incorporating procalcitonin, C-reactive protein, and urinary dipstick results.
- Assessment of the predictive value of this combined index for severe bacterial infections.
Main Results:
- No single perfect marker currently exists to reliably differentiate bacterial from viral infections in febrile children.
- A combined risk index using procalcitonin, C-reactive protein, and urinary dipstick has shown promising predictive value.
- This simplified approach may offer improved diagnostic accuracy compared to individual markers or complex rules.
Conclusions:
- The combination of procalcitonin, C-reactive protein, and urinary dipstick in a risk index score presents a potentially valuable tool for diagnosing severe bacterial infections in children.
- Further impact analyses are required to confirm improved quality of care and clinical utility in real-world settings.
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