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Determinants of infection for antibiotic initiation at pediatric emergency admission: A prospective observational
Samreen Yusuf1, Anil K Goel2, Ashish Wasudeo Khobragade3
1Division of Pediatrics Emergency Medicine, Department of Pediatrics, All India Institute of Medical Sciences, Raipur 492099, Chhattīsgarh, India.
Insights
Early diagnosis of pediatric bacterial infections is challenging. The Children's Antibiotic Requirement Evaluation Score (CARES) Index combines clinical signs and C-reactive protein for better detection in emergency settings.
Area of Science:
- Pediatric Emergency Medicine
- Infectious Diseases
- Clinical Diagnostics
Background:
- Early sepsis diagnosis in children is difficult due to non-specific symptoms and lack of awareness.
- Overlapping clinical features, especially in infants, complicate accurate and timely identification of bacterial infections.
Purpose of the Study:
- To identify key determinants of bacterial infection in children admitted to a pediatric emergency medicine unit.
- To develop a scoring system for guiding antibiotic initiation within the first hour of care.
Main Methods:
- A prospective observational study was conducted in a tertiary care hospital's pediatric emergency medicine unit.
- A scoring system, the Children's Antibiotic Requirement Evaluation Score (CARES) Index, was developed based on identified clinical determinants and point-of-care investigations.
Main Results:
- The study enrolled 802 children, identifying abnormal color, fever, fluid overload, altered sensorium, cellulitis, prior antibiotic use, and C-reactive protein as significant infection predictors.
- The CARES Index demonstrated moderate accuracy in identifying infection determinants for timely antibiotic initiation.
- Point-of-care investigations showed high sensitivity for erythrocyte sedimentation rate (80%) and high specificity for procalcitonin (75.31%).
Conclusions:
- Clinical parameters, symptoms, and point-of-care investigations are associated with pediatric bacterial infections.
- Several factors are strong predictors of sepsis, but no single factor provides a definitive diagnosis.
- The CARES Index aids in the early detection and management of bacterial infections in pediatric emergency settings.
Background:
Due to non-specific and overlapping features, particularly in infants, and a lack of awareness of important signs and symptoms, early diagnosis of sepsis is difficult.
Aim:
To identify the determinants for bacterial infection based on clinical evidence and point-of-care (POC) investigations in children at admission to a pediatric emergency medicine (PEM) unit.
Methods:
This prospective observational study was conducted in a PEM unit of a tertiary care hospital in Central India. A scoring system based on these determinants for initiation of antibiotics in the golden hour (i.e. the first 60 minutes) was developed, termed as the Children's Antibiotic Requirement Evaluation Score (CARES) Index.
Results:
Out of a total of 1419 children presenting to the PEM, 802 children were enrolled. The best predictors of infection were found to be abnormal color, fever, features of fluid overload, altered sensorium, cellulitis, use of antibiotics, and C-reactive protein. These parameters were amalgamated to form the CARES Index, which showed moderate accuracy for determinants of infection for initiation of antibiotics in a pediatric emergency. Among the POC investigations, the sensitivity of the erythrocyte sedimentation rate (80.00%) was maximum, while specificity was highest for procalcitonin (75.31%).
Conclusion:
We highlighted the association of clinical parameters, symptoms, and POC investigations in pediatric bacterial infections. Some parameters emerged as strong predictors of sepsis, and no single factor was sufficient for a definitive diagnosis.
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