Predictive model for serious bacterial infections among infants younger than 3 months of age
- PMID: 11483793
- DOI: 10.1542/peds.108.2.311
Predictive model for serious bacterial infections among infants younger than 3 months of age
Abstract
Objective: To develop a data-derived model for predicting serious bacterial infection (SBI) among febrile infants <3 months old.
Methods: All infants </=90 days old with a temperature >/=38.0 degrees C seen in an urban emergency department (ED) were retrospectively identified. SBI was defined as a positive culture of urine, blood, or cerebrospinal fluid. Tree-structured analysis via recursive partitioning was used to develop the model. SBI or No-SBI was the dichotomous outcome variable, and age, temperature, urinalysis (UA), white blood cell (WBC) count, absolute neutrophil count, and cerebrospinal fluid WBC were entered as potential predictors. The model was tested by V-fold cross-validation.
Results: Of 5279 febrile infants studied, SBI was diagnosed in 373 patients (7%): 316 urinary tract infections (UTIs), 17 meningitis, and 59 bacteremia (8 with meningitis, 11 with UTIs). The model sequentially used 4 clinical parameters to define high-risk patients: positive UA, WBC count >/=20 000/mm(3) or </=4100/mm(3), temperature >/=39.6 degrees C, and age <13 days. The sensitivity of the model for SBI is 82% (95% confidence interval [CI]: 78%-86%) and the negative predictive value is 98.3% (95% CI: 97.8%-98.7%). The negative predictive value for bacteremia or meningitis is 99.6% (95% CI: 99.4%-99.8%). The relative risk between high- and low-risk groups is 12.1 (95% CI: 9.3-15.6). Sixty-six SBI patients (18%) were misclassified into the lower risk group: 51 UTIs, 14 with bacteremia, and 1 with meningitis.
Conclusions: Decision-tree analysis using common clinical variables can reasonably predict febrile infants at high-risk for SBI. Sequential use of UA, WBC count, temperature, and age can identify infants who are at high risk of SBI with a relative risk of 12.1 compared with lower-risk infants.
Similar articles
-
A Clinical Prediction Rule to Identify Febrile Infants 60 Days and Younger at Low Risk for Serious Bacterial Infections.JAMA Pediatr. 2019 Apr 1;173(4):342-351. doi: 10.1001/jamapediatrics.2018.5501. JAMA Pediatr. 2019. PMID: 30776077 Free PMC article.
-
Enhanced urinalysis improves identification of febrile infants ages 60 days and younger at low risk for serious bacterial illness.Pediatrics. 2001 Oct;108(4):866-71. doi: 10.1542/peds.108.4.866. Pediatrics. 2001. PMID: 11581437
-
Factors associated with serious bacterial infections in infants ≤60 days with hypothermia in the emergency department.Am J Emerg Med. 2019 Jun;37(6):1139-1143. doi: 10.1016/j.ajem.2019.04.015. Epub 2019 Apr 11. Am J Emerg Med. 2019. PMID: 31006603
-
Sepsis workup in febrile infants 0-90 days of age with respiratory syncytial virus infection.Pediatr Emerg Care. 2003 Oct;19(5):314-9. doi: 10.1097/01.pec.0000092576.40174.28. Pediatr Emerg Care. 2003. PMID: 14578830 Review.
-
Diagnosis and management of febrile infants (0-3 months).Evid Rep Technol Assess (Full Rep). 2012 Mar;(205):1-297. Evid Rep Technol Assess (Full Rep). 2012. PMID: 24422856 Free PMC article. Review.
Cited by 50 articles
-
Integrating Clinical Signs at Presentation and Clinician's Non-analytical Reasoning in Prediction Models for Serious Bacterial Infection in Febrile Children Presenting to Emergency Department.Front Pediatr. 2022 Apr 25;10:786795. doi: 10.3389/fped.2022.786795. eCollection 2022. Front Pediatr. 2022. PMID: 35547543 Free PMC article.
-
[Correlations between Obtaining Fever Management Information from the Internet and Knowledge and Practices of Fever Management by Mothers of Infants and Toddlers].Child Health Nurs Res. 2020 Apr;26(2):190-200. doi: 10.4094/chnr.2020.26.2.190. Epub 2020 Apr 30. Child Health Nurs Res. 2020. PMID: 35004464 Free PMC article. Korean.
-
Diagnosis and therapeutic decision-making for the neutropenic patient.Hematology Am Soc Hematol Educ Program. 2021 Dec 10;2021(1):492-503. doi: 10.1182/hematology.2021000284. Hematology Am Soc Hematol Educ Program. 2021. PMID: 34889413 Free PMC article.
-
Catheter-Obtained Urine Culture Contamination Among Young Infants: A Prospective Cohort Study.Front Pediatr. 2021 Nov 1;9:762577. doi: 10.3389/fped.2021.762577. eCollection 2021. Front Pediatr. 2021. PMID: 34790635 Free PMC article.
-
Infants Younger Than 90 Days Admitted for Late-Onset Sepsis Display a Reduced Abundance of Regulatory T Cells.Front Immunol. 2021 Aug 27;12:666447. doi: 10.3389/fimmu.2021.666447. eCollection 2021. Front Immunol. 2021. PMID: 34512621 Free PMC article.
MeSH terms
LinkOut - more resources
Full Text Sources
Medical