Clinical prediction model to aid emergency doctors managing febrile children at risk of serious bacterial infections: Diagnostic study

Department of General Paediatrics, Erasmus MC-Sophia Children's Hospital, 3015 GJ, Rotterdam, Netherlands.
BMJ (online) (Impact Factor: 17.45). 04/2013; 346(apr02 1):f1706. DOI: 10.1136/bmj.f1706
Source: PubMed


To derive, cross validate, and externally validate a clinical prediction model that assesses the risks of different serious bacterial infections in children with fever at the emergency department.
Prospective observational diagnostic study.
Three paediatric emergency care units: two in the Netherlands and one in the United Kingdom.
Children with fever, aged 1 month to 15 years, at three paediatric emergency care units: Rotterdam (n=1750) and the Hague (n=967), the Netherlands, and Coventry (n=487), United Kingdom. A prediction model was constructed using multivariable polytomous logistic regression analysis and included the predefined predictor variables age, duration of fever, tachycardia, temperature, tachypnoea, ill appearance, chest wall retractions, prolonged capillary refill time (>3 seconds), oxygen saturation <94%, and C reactive protein.
Pneumonia, other serious bacterial infections (SBIs, including septicaemia/meningitis, urinary tract infections, and others), and no SBIs.
Oxygen saturation <94% and presence of tachypnoea were important predictors of pneumonia. A raised C reactive protein level predicted the presence of both pneumonia and other SBIs, whereas chest wall retractions and oxygen saturation <94% were useful to rule out the presence of other SBIs. Discriminative ability (C statistic) to predict pneumonia was 0.81 (95% confidence interval 0.73 to 0.88); for other SBIs this was even better: 0.86 (0.79 to 0.92). Risk thresholds of 10% or more were useful to identify children with serious bacterial infections; risk thresholds less than 2.5% were useful to rule out the presence of serious bacterial infections. External validation showed good discrimination for the prediction of pneumonia (0.81, 0.69 to 0.93); discriminative ability for the prediction of other SBIs was lower (0.69, 0.53 to 0.86).
A validated prediction model, including clinical signs, symptoms, and C reactive protein level, was useful for estimating the likelihood of pneumonia and other SBIs in children with fever, such as septicaemia/meningitis and urinary tract infections.

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    • "The test aims at differentiating bacterial infections from viral/less severe infections, and after its introduction as a point-of-care test, it has been widely used in Norway: at 35 % of all consultations at OOH-services[10]. Compared to most other countries the CRP test is used clearly more frequent in Norway and reasons for such variations should be assessed, especially since the benefit of using the test has been discussed141516. Different factors seem to influence use of the test: the age, gender and experience of the doctor, as well as the geographical centrality and organization of the OOH service[12]. "
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