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Thompson M, Van den Bruel A, Verbakel J, et al. Systematic Review and Validation of Prediction Rules for Identifying Children with Serious Infections in Emergency Departments and Urgent-Access Primary Care. Southampton (UK): NIHR Journals Library; 2012 Mar. (Health Technology Assessment, No. 16.15.)

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Systematic Review and Validation of Prediction Rules for Identifying Children with Serious Infections in Emergency Departments and Urgent-Access Primary Care.

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Appendix 3Details of clinical features and cut-off values in prediction rules included in Chapter 6

StudyTests included in prediction ruleCut-offScore
Baker 199346Infant Observation Scale or> 10Positive
WBC or≥ 15,000/mm3Positive
Spun urine specimen with or positive on bright-field microscopy or≥ 10 WBC/HPFPositive
CSF WBC or≥ 8/mm3Positive
Positive Gram stain or
Infiltrate on chest radiographPositive
Baker 199947Ill appearance orPositive
WBC or≥ 15,000/mm3Positive
Spun urine specimen with ≥ 10 WBC/HPF or positive on bright-field microscopy orPositive
CSF WBC or≥ 8/mm3Positive
Positive Gram stain or
Infiltrate on chest radiographPositive
Bleeker 200750WBC (× 109/l)< 100
10–192
20–294
30–396
≥ 408
Serum CRP (mg/l)0–99First integer
≥ 100First and second integers

Maximum = 16 points
≥ 70 WBC/μl in dipstick urinalysisNo0
Yes9
Bonadio 199351Milwaukee protocolPositive if not fulfilling the protocol
Physical examination with normal clinical appearance and no sign of focal infection
Normal laboratory data:
 CSF WBC count< 10/ml
 CBC WBC count< 15,000/ml
 Urinalysis WBC/HPF≤ 5–10
 And no bacteria/HPF
 Dipstick for leucocyte esterase and nitriteNegative
 Chest radiograph if performedNo Infiltrate
Reliable caretaker
No allergy to beta-lactam antibiotics
Private paediatrician contact
Galetto-Lacour 200152PCT or>0.9 ng/mlPositive
CRP>40 mg/lPositive
Galetto-Lacour 200152PCT or>0.9 ng/mlPositive
WBC>15,000/mm3Positive
Galetto-Lacour 200854PCT< 0.50
≥ 0.52
≥ 24
CRP< 400
40–992
≥ 1004
Urine dipstickNegative0
Positive1
Garra 200555Philadelphia protocolPositive if not fulfilling the protocol
Infant observation score ≤ 10
No recognisable bacterial infection on examination
WBC< 15,000/mm3
Band-to-neutrophil ratio < 0.2
Urine: WBC< 10/mm3
And few bacteria per HPF
CSF: WBC< 8/mm3
And a negative Gram stain
Chest radiographNo Infiltrate
Stool smear negative for blood and few or no WBC (for infants with diarrhoea)
Thayyil 200560PCT, and> 2Positive
CRP, and> 50
WBC> 15

CBC, complete blood count; HPF, high-power field.

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Included under terms of UK Non-commercial Government License.

Bookshelf ID: NBK97758

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