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Age Less Than 24 Months is Not an Independent Risk Factor for Serious Bacterial Illness in Febrile Children with
Jessica E Briggs1, Leya Schwartz2, Daniel M Fein3
1Division of Pediatric Hematology, Oncology, and Cellular Therapy, Department of Pediatrics, Children's Hospital at Montefiore/Albert Einstein College of Medicine, Bronx, New York.
Insights
Age is not a significant risk factor for serious bacterial illness (SBI) in febrile children with sickle cell disease (SCD). A screening tool effectively identified high-risk patients across different age groups, suggesting current guidelines may be refined.
Area of Science:
- Pediatric Hematology
- Infectious Diseases
- Clinical Risk Stratification
Background:
- Children with sickle cell disease (SCD) face a heightened risk of serious bacterial illness (SBI).
- Screening tools are crucial for identifying high-risk pediatric SCD patients needing hospitalization.
- This study investigates if age is an independent risk factor for SBI in febrile children with SCD.
Purpose of the Study:
- To compare the efficacy of a screening tool in identifying high-risk SBI patients with SCD.
- To evaluate performance in children aged 6-24 months versus those older than 24 months.
Main Methods:
- Retrospective cohort study of pediatric patients with SCD presenting with fever.
- Application of a screening tool to categorize SBI risk (high/low).
- Comparison of sensitivity, specificity, PPV, and NPV between two age groups (6-24 months vs. >24 months).
Main Results:
- 1198 patient encounters were analyzed.
- SBI prevalence was 11% in the 6-24 month group and 23% in the >24 month group.
- No significant differences in sensitivity (86% vs. 93%) or NPV (98% vs. 97%) between age groups.
Conclusions:
- The screening tool demonstrated comparable performance in identifying SBI risk across both age groups.
- Findings suggest that age less than 24 months is not an independent risk factor for SBI in febrile children with SCD.
- This implies potential for refining current risk stratification guidelines based on age.
Background:
Children with sickle cell disease (SCD) are at increased risk of serious bacterial illness (SBI). Screening tools are employed to identify children with SCD at high risk for SBI who require hospital admission. Our hypothesis is that age alone is not an independent risk factor for SBI in febrile children with SCD.
Objectives:
To compare the ability of our screening tool to identify patients at high risk for SBI in febrile patients with SCD between 6 and 24 months of age vs. > 24 months.
Methods:
This was a retrospective cohort study including pediatric patients with SCD who were evaluated after presenting with fever. We applied our screening tool to categorize patients as high or low risk for SBI at each encounter. We compared the ability of the screening tool to accurately predict which patients were at high risk for SBI in two age groups, using sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV).
Results:
A total of 1198 encounters were analyzed. SBI was present in 35 (11%) of those 6-24 months of age and 200 (23%) > 24 months. There was no statistically significant difference between groups in sensitivity: 86% in 6-24 months and 93% in > 24 months (p = 0.19), or NPV: 98% in 6-24 months and 97% in > 24 months (p = 0.63).
Conclusion:
There was no significant difference in the sensitivity and NPV of our screening test to identify SBI in febrile children with SCD in our two age cohorts. These findings suggest that age < 24 months is not an independent risk factor for SBI.
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