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Accuracy of a sequential approach to identify young febrile infants at low risk for invasive bacterial infection.
- Source :
-
Emergency medicine journal : EMJ [Emerg Med J] 2014 Oct; Vol. 31 (e1), pp. e19-24. Date of Electronic Publication: 2013 Jul 14. - Publication Year :
- 2014
-
Abstract
- Introduction: Much effort has been put in the past years to create and assess accurate tools for the management of febrile infants. However, no optimal strategy has been so far identified. A sequential approach evaluating, first, the appearance of the infant, second, the age and result of the urinanalysis and, finally, the results of the blood biomarkers, including procalcitonin, may better identify low risk febrile infants suitable for outpatient management.<br />Objective: To assess the value of a sequential approach ('step by step') to febrile young infants in order to identify patients at a low risk for invasive bacterial infections (IBI) who are suitable for outpatient management and compare it with other previously described strategies such as the Rochester criteria and the Lab-score.<br />Methods: A retrospective comparison of three different approaches (step by step, Lab-score and Rochester criteria) was carried out in 1123 febrile infants less than 3 months of age attended in seven European paediatric emergency departments. IBI was defined as isolation of a bacterial pathogen from the blood or cerebrospinal fluid.<br />Results: Of the 1123 infants (IBI 48; 4.2%), 488 (43.4%) were classified as low-risk criteria according to the step by step approach (vs 693 (61.7%) with the Lab-score and 458 (40.7%) with the Rochester criteria). The prevalence of IBI in the low-risk criteria patients was 0.2% (95% CI 0% to 0.6%) using the step by step approach; 0.7% (95% CI 0.1% to 1.3%) using the Lab-score; and 1.1% (95% CI 0.1% to 2%) using the Rochester criteria. Using the step by step approach, one patient with IBI was not correctly classified (2.0%, 95% CI 0% to 6.12%) versus five using the Lab-score or Rochester criteria (10.4%, 95% CI 1.76% to 19.04%).<br />Conclusions: A sequential approach to young febrile infants based on clinical and laboratory parameters, including procalcitonin, identifies better patients more suitable for outpatient management.<br /> (Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.)
- Subjects :
- Age Factors
Ambulatory Care
Bacterial Infections metabolism
Biomarkers blood
Calcitonin blood
Calcitonin Gene-Related Peptide
Female
Fever of Unknown Origin metabolism
Fever of Unknown Origin therapy
Humans
Infant
Male
Patient Selection
Protein Precursors blood
Retrospective Studies
Risk
Sensitivity and Specificity
Urinalysis
Bacterial Infections complications
Bacterial Infections diagnosis
Fever of Unknown Origin etiology
Subjects
Details
- Language :
- English
- ISSN :
- 1472-0213
- Volume :
- 31
- Issue :
- e1
- Database :
- MEDLINE
- Journal :
- Emergency medicine journal : EMJ
- Publication Type :
- Academic Journal
- Accession number :
- 23851127
- Full Text :
- https://doi.org/10.1136/emermed-2013-202449