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Lack of Accuracy of Biomarkers and Physical Examination to Detect Bacterial Infection in Febrile Infants
- Source :
- Pediatric emergency care. 32(10)
- Publication Year :
- 2016
-
Abstract
- The aim of this study was to analyze the usefulness of physical examination, C-reactive protein (CRP), procalcitonin (PCT), white blood cell (WBC) count, and absolute neutrophils counts (ANCs) for the diagnosis of invasive bacterial infections (IBIs) and potentially serious bacterial infections in infants younger than the age of 3 months presenting with fever without source (FWS) to the emergency department (ED).A descriptive retrospective study that includes all infants aged younger than 3 months who presented with FWS to the ED between July 2008 and January 2012. We evaluated diagnostic performance for each test by receiver operating characteristic curve analysis. Sensitivity, specificity, positive likelihood ratio, and negative likelihood ratio were also calculated.Three hundred eighteen patients met the inclusion criteria. Eleven bacteremia (3.5%) and 76 urinary tract infections (23.9%) were diagnosed. To detect IBI, the areas under the curve for the different tests were as follows: PCT, 0.77 (95% confidence interval [CI], 0.57-0.96); CRP, 0.54 (95% CI, 0.36-0.73); ANC, 0.53 (95% CI, 0.34-0.71); and WBC, 0.42 (0.24-0.61). To detect potentially serious bacterial infections, the areas under the curve were as follows: PCT, 0.66 (95% CI, 0.59-0.74); CRP, 0.68 (0.60-0.76); ANC, 0.64 (0.56-0.71); and WBC, 0.66 (0.58-0.72).Procalcitonin is better than CRP, WBC, and ANC to confirm or dismiss the presence of an IBI in infants aged younger than 3 months presenting with FWS to the ED. However, it could not identify almost 30% of infants with IBI. Most patients diagnosed with IBI (10 of 11) presented abnormal values in at least one of the analytical parameters and/or physical appearance. Four of 5 patients with IBI and well appearing presented abnormal results in at least one of the analytical parameters. Therefore, the development of tools combining different tests including the new biomarkers could increase the reliability of the tests for the diagnosis of IBI in these patients.
- Subjects :
- Calcitonin
Male
medicine.medical_specialty
Neutrophils
MEDLINE
Physical examination
Bacteremia
Fever of Unknown Origin
Procalcitonin
03 medical and health sciences
Leukocyte Count
0302 clinical medicine
hemic and lymphatic diseases
030225 pediatrics
White blood cell
parasitic diseases
medicine
Humans
030212 general & internal medicine
Intensive care medicine
Retrospective Studies
medicine.diagnostic_test
business.industry
Infant, Newborn
Infant
Retrospective cohort study
General Medicine
bacterial infections and mycoses
medicine.anatomical_structure
C-Reactive Protein
ROC Curve
Pediatrics, Perinatology and Child Health
Urinary Tract Infections
Emergency Medicine
Female
business
Emergency Service, Hospital
hormones, hormone substitutes, and hormone antagonists
Biomarkers
Subjects
Details
- ISSN :
- 15351815
- Volume :
- 32
- Issue :
- 10
- Database :
- OpenAIRE
- Journal :
- Pediatric emergency care
- Accession number :
- edsair.doi.dedup.....dd115932ec729835f18de815d03f84b4