BACKGROUND: Many efforts have been done 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, firstly, the appearance of the infant, secondly, the age and result of the urinanalysis, and, finally, the results of the blood biomarkers, including procalcitonin, may identify better low risk febrile infants suitable for outpatient management. OBJECTIVE: To assess the value of a sequential approach (“step by step”) to febrile young infants in order to identify patients at 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. DESIGN/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 Pediatric Emergency Departments. IBI was defined as isolation of a bacterial pathogen from the blood or cerebrospinal fluid. 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 Labscore and 458 -40.7%- with the Rochester criteria). The prevalence of IBI in the low-risk criteria patients was 0.2% (95% CI 0-0.6%) using the “step by step” approach; 0.7% (95% CI 0.1-1.3%) using the Labscore; and 1.1% (95% CI 0.1-2%) using the Rochester criteria. Using the “step by step” approach, 1 patient with IBI was not correctly classified (2.0%, 95% CI 0-6.12%) vs 5 using the Labscore or Rochester criteria (10.4%, 95% CI 1.76-19.04%). CONCLUSIONS: A sequential approach to young febrile infants based on clinical and laboratory parameters, including procalcitonin, identifies better patients more suitable for outpatient management.
Accuracy of a Sequential Approach To Identify Young Febrile Infants at Low Risk for Invasive Bacterial Infection
BRESSAN, SILVIA;DA DALT, LIVIANA;
2013
Abstract
BACKGROUND: Many efforts have been done 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, firstly, the appearance of the infant, secondly, the age and result of the urinanalysis, and, finally, the results of the blood biomarkers, including procalcitonin, may identify better low risk febrile infants suitable for outpatient management. OBJECTIVE: To assess the value of a sequential approach (“step by step”) to febrile young infants in order to identify patients at 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. DESIGN/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 Pediatric Emergency Departments. IBI was defined as isolation of a bacterial pathogen from the blood or cerebrospinal fluid. 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 Labscore and 458 -40.7%- with the Rochester criteria). The prevalence of IBI in the low-risk criteria patients was 0.2% (95% CI 0-0.6%) using the “step by step” approach; 0.7% (95% CI 0.1-1.3%) using the Labscore; and 1.1% (95% CI 0.1-2%) using the Rochester criteria. Using the “step by step” approach, 1 patient with IBI was not correctly classified (2.0%, 95% CI 0-6.12%) vs 5 using the Labscore or Rochester criteria (10.4%, 95% CI 1.76-19.04%). CONCLUSIONS: A sequential approach to young febrile infants based on clinical and laboratory parameters, including procalcitonin, identifies better patients more suitable for outpatient management.
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