Validation and comparison of the PECARN rule, Step-by-Step approach and Lab-score for predicting serious and invasive bacterial infections in young febrile infants

Sutiman, Natalia; Khoo, Zi Xean; Ong, Gene Yong-Kwang; Piragasam, Rupini; Chong, Shu-Ling

doi:10.47102/annals-acadmedsg.2022193

Cited by 8 publications

(4 citation statements)

References 26 publications

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“…Existing published clinical prediction rules have variable performance in different populations. A prior external validation of the PECARN rule in our population reported a sensitivity of 88.9%, specificity of 28.9%, and a ROC of 0.59 (0.42–0.76) 19 . These studies focus on identifying a group at low risk of SBI 1 , while our aim is to derive a tool that predicts for SBI, thereby serving as an adjunct to help clinicians prioritize which febrile infant requires urgent further investigations and management.…”

Section: Discussionmentioning

confidence: 67%

Febrile infants risk score at triage (FIRST) for the early identification of serious bacterial infections

Chong,

Niu,

Ong

et al. 2023

Sci Rep

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We aimed to derive the Febrile Infants Risk Score at Triage (FIRST) to quantify risk for serious bacterial infections (SBIs), defined as bacteremia, meningitis and urinary tract infections. We performed a prospective observational study on febrile infants < 3 months old at a tertiary hospital in Singapore between 2018 and 2021. We utilized machine learning and logistic regression to derive 2 models: FIRST, based on patient demographics, vital signs and history, and FIRST + , adding laboratory results to the same variables. SBIs were diagnosed in 224/1002 (22.4%) infants. Among 994 children with complete data, age (adjusted odds ratio [aOR] 1.01 95%CI 1.01–1.02, p < 0.001), high temperature (aOR 2.22 95%CI 1.69–2.91, p < 0.001), male sex (aOR 2.62 95%CI 1.86–3.70, p < 0.001) and fever of ≥ 2 days (aOR 1.79 95%CI 1.18–2.74, p = 0.007) were independently associated with SBIs. For FIRST + , abnormal urine leukocyte esterase (aOR 16.46 95%CI 10.00–27.11, p < 0.001) and procalcitonin (aOR 1.05 95%CI 1.01–1.09, p = 0.009) were further identified. A FIRST + threshold of ≥ 15% predicted risk had a sensitivity of 81.8% (95%CI 70.5–91.0%) and specificity of 65.6% (95%CI 57.8–72.7%). In the testing dataset, FIRST + had an area under receiver operating characteristic curve of 0.87 (95%CI 0.81–0.94). These scores can potentially guide triage and prioritization of febrile infants.

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Section: Discussionmentioning

confidence: 67%

Febrile infants risk score at triage (FIRST) for the early identification of serious bacterial infections

Chong,

Niu,

Ong

et al. 2023

Sci Rep

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“…Our risk assessment tool that included practical, commonly collected clinical variables and was developed at sites in East and West Africa allows for greater generalisability than previous risk assessment tools for post-discharge mortality developed in single countries 10 11. The optimism corrected AUC of our tool aligns with prior risk assessment tools for post-discharge mortality among young children and would be considered acceptable for clinical use and aligns with test characteristics of other risk assessment tools that have been incorporated into clinical practice 57–61. However, because risk assessment tools perform best in their derivation set,15 this tool must be externally validated prior to clinical use.…”

Section: Discussionmentioning

confidence: 91%

“…10 11 The optimism corrected AUC of our tool aligns with prior risk assessment tools for post-discharge mortality among young children and would be considered acceptable for clinical use and aligns with test characteristics of other risk assessment tools that have been incorporated into clinical practice. [57][58][59][60][61] However, because risk assessment tools perform best in their derivation set, 15 this tool must be externally validated prior to clinical use. Although there were some differences in demographics of neonates discharged from the two included sites, our risk assessment tool may be more generalisable than prior tools as this is the first to overcome the inherent limitation of single-centre studies on post-discharge mortality.…”

Section: Discussionmentioning

confidence: 99%

Identifying neonates at risk for post-discharge mortality in Dar es Salaam, Tanzania, and Monrovia, Liberia: Derivation and internal validation of a novel risk assessment tool

Rees,

Ideh,

Kisenge

et al. 2024

BMJ Open

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IntroductionThe immediate period after hospital discharge carries a large burden of childhood mortality in sub-Saharan Africa. Our objective was to derive and internally validate a risk assessment tool to identify neonates discharged from the neonatal ward at risk for 60-day post-discharge mortality.MethodsWe conducted a prospective observational cohort study of neonates discharged from Muhimbili National Hospital in Dar es Salaam, Tanzania, and John F Kennedy Medical Centre in Monrovia, Liberia. Research staff called caregivers to ascertain vital status up to 60 days after discharge. We conducted multivariable logistic regression analyses with best subset selection to identify socioeconomic, demographic, clinical, and anthropometric factors associated with post-discharge mortality. We used adjusted log coefficients to assign points to each variable and internally validated our tool with bootstrap validation with 500 repetitions.ResultsThere were 2344 neonates discharged and 2310 (98.5%) had post-discharge outcomes available. The median (IQR) age at discharge was 8 (4, 15) days; 1238 (53.6%) were male. In total, 71 (3.1%) died during follow-up (26.8% within 7 days of discharge). Leaving against medical advice (adjusted OR [aOR] 5.62, 95% CI 2.40 to 12.10) and diagnosis of meconium aspiration (aOR 6.98, 95% CI 1.69 to 21.70) conferred the greatest risk for post-discharge mortality. The risk assessment tool included nine variables (total possible score=63) and had an optimism corrected area under the receiver operating characteristic curve of 0.77 (95% CI 0.75 to 0.80). A score of ≥6 was most optimal (sensitivity 68.3% [95% CI 64.8% to 71.5%], specificity 72.1% [95% CI 71.5% to 72.7%]).ConclusionsA small number of factors predicted all-cause, 60-day mortality after discharge from neonatal wards in Tanzania and Liberia. After external validation, this risk assessment tool may facilitate clinical decision making for eligibility for discharge and the direction of resources to follow-up high risk neonates.

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“…The international literature shows various diagnostic protocols to distinguish low-risk situations from the high possibility of severe bacterial infection. However, none of them were demonstrated to be superior to the others [13,14]. The most important risk factors for severe bacterial infection are an age < 3 months of life, comorbidities, and immunodeficiencies [15].…”

Section: Of 14mentioning

confidence: 99%

Retrospective Analysis of Fever in Pediatric Age: Our Experience over the Last 5 Years

Valenzise,

D’Amico,

La Barbera

et al. 2024

Children

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Background: Fever is one of the most frequent symptoms highlighted during medical assistance. Due to this great impact, our study has the purpose of analyzing the demographic and laboratory characteristics of patients hospitalized in our center and identifying predictive markers to make the differential diagnosis between infectious and non-infectious fever. Methods: Our population included 220 children, collected from January 2017 to August 2022, hospitalized for continuous fever (4 days or more in duration with at least one temperature peak ≥37.5 °C) and excluded cases of discharge against medical advice and/or transfer to other operating units. Demographic (mean age at the time of admission, frequency of hospitalization, and mean days of hospitalization), laboratory, and instrumental variables were analyzed in order to find correlation with fever etiology. Results: Older age at the time of hospitalization, family history of periodic fever, fever lasting more than 8 days, and longer hospitalization are strongly associated with non-infectious fever, together with anemia, high platelet count, high CRP and ferritin, and hyponatremia at the time of admission. Paracetamol is the preferred antipyretic treatment. Echocardiogram has shown anomalies in patients with infectious fever, while ECG anomalies were detected in non-infectious fever. Conclusions: Our data underline the importance of predictive markers, such as clinical and laboratory parameters, to differentiate infectious from non-infectious fevers, but further studies are necessary.

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Validation and comparison of the PECARN rule, Step-by-Step approach and Lab-score for predicting serious and invasive bacterial infections in young febrile infants

Cited by 8 publications

References 26 publications

Febrile infants risk score at triage (FIRST) for the early identification of serious bacterial infections

Febrile infants risk score at triage (FIRST) for the early identification of serious bacterial infections

Identifying neonates at risk for post-discharge mortality in Dar es Salaam, Tanzania, and Monrovia, Liberia: Derivation and internal validation of a novel risk assessment tool

Retrospective Analysis of Fever in Pediatric Age: Our Experience over the Last 5 Years

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