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Pediatrics. 2019 Jul;144(1). pii: e20183604. doi: 10.1542/peds.2018-3604. Epub 2019 Jun 5.

A Prediction Model to Identify Febrile Infants ≤60 Days at Low Risk of Invasive Bacterial Infection.

Author information

1
Departments of Pediatrics and paul.aronson@yale.edu.
2
Emergency Medicine, Yale School of Medicine and.
3
Departments of Pediatrics and.
4
Department of Epidemiology of Microbial Diseases, Yale University, New Haven, Connecticut.
5
Division of Pediatric Hospital Medicine, Department of Pediatrics, Lucile Packard Children's Hospital Stanford and School of Medicine, Stanford University, Palo Alto, California.
6
Division of Emergency Medicine, Department of Pediatrics, Boston Children's Hospital and Harvard Medical School, Harvard University, Boston, Massachusetts.
7
Division of Pediatric Emergency Medicine, Department of Pediatrics, University of Alabama at Birmingham, Birmingham, Alabama.
8
Division of Hospital Medicine, Department of Pediatrics, Children's Mercy Hospital, Kansas City, Missouri.
9
Division of Hospital Medicine, Department of Pediatrics, Children's Hospital of the King's Daughters, Norfolk, Virginia.
10
Divisions of Hospital Medicine and.
11
Divisions of Pediatric Emergency Medicine and.
12
Division of Emergency Medicine, Ann and Robert H. Lurie Children's Hospital of Chicago and Feinberg School of Medicine, Northwestern University, Chicago, Illinois.
13
Division of Hospital Medicine, Department of Pediatrics, Seattle Children's Hospital and School of Medicine, University of Washington, Seattle, Washington; and.
14
Division of Emergency Medicine and.
15
Department of Pediatrics, Center for Pediatric Clinical Effectiveness, Children's Hospital of Philadelphia and Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
16
Infectious Diseases, Department of Pediatrics, Cincinnati Children's Hospital Medical Center and University of Cincinnati College of Medicine, Cincinnati, Ohio.
17
Hospital Medicine, Department of Pediatrics, Monroe Carell Jr. Children's Hospital at Vanderbilt and School of Medicine, Vanderbilt University, Nashville, Tennessee.

Abstract

OBJECTIVES:

To derive and internally validate a prediction model for the identification of febrile infants ≤60 days old at low probability of invasive bacterial infection (IBI).

METHODS:

We conducted a case-control study of febrile infants ≤60 days old who presented to the emergency departments of 11 hospitals between July 1, 2011 and June 30, 2016. Infants with IBI, defined by growth of a pathogen in blood (bacteremia) and/or cerebrospinal fluid (bacterial meningitis), were matched by hospital and date of visit to 2 control patients without IBI. Ill-appearing infants and those with complex chronic conditions were excluded. Predictors of IBI were identified with multiple logistic regression and internally validated with 10-fold cross-validation, and an IBI score was calculated.

RESULTS:

We included 181 infants with IBI (155 [85.6%] with bacteremia without meningitis and 26 [14.4%] with bacterial meningitis) and 362 control patients. Twenty-three infants with IBI (12.7%) and 138 control patients (38.1%) had fever by history only. Four predictors of IBI were identified (area under the curve 0.83 [95% confidence interval (CI): 0.79-0.86]) and incorporated into an IBI score: age <21 days (1 point), highest temperature recorded in the emergency department 38.0-38.4°C (2 points) or ≥38.5°C (4 points), absolute neutrophil count ≥5185 cells per μL (2 points), and abnormal urinalysis results (3 points). The sensitivity and specificity of a score ≥2 were 98.8% (95% CI: 95.7%-99.9%) and 31.3% (95% CI: 26.3%-36.6%), respectively. All 26 infants with meningitis had scores ≥2.

CONCLUSIONS:

Infants ≤60 days old with fever by history only, a normal urinalysis result, and an absolute neutrophil count <5185 cells per μL have a low probability of IBI.

PMID:
31167938
PMCID:
PMC6615531
[Available on 2020-07-01]
DOI:
10.1542/peds.2018-3604

Conflict of interest statement

POTENTIAL CONFLICT OF INTEREST: Drs Shapiro and Neuman have served as expert witnesses in malpractice cases involving the evaluation of infants with infections; the other authors have indicated they have no potential conflicts of interest to disclose.

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