Validation of the “Step-by-Step” Approach in the Management of Young Febrile Infants

Gómez, Borja; Mintegi, Santiago; Bressan, Silvia; Dalt, Liviana Da; Gervaix, Alain; Lacroix, Laurence

doi:10.1542/peds.2015-4381

Cited by 255 publications

(332 citation statements)

References 38 publications

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“…40 However, external validation studies focusing on well-appearing infants <3 months of age using this prediction model have reported high specificity but low sensitivity for detection of SBI and IBI (Tables 2 and 3). 41,42 Most recently, Gomez et al validated the “Step-by-Step” approach for risk stratification of infants ≤90 days old with FWS. 47 This approach uses age, clinical appearance, urine dipstick, PCT, CRP, and absolute neutrophil count (ANC) in a stepwise fashion to determine which infants are high-, intermediate-, and low-risk for SBI and IBI (Table 4).…”

Section: Are There New Diagnostic Tools That Can Be Incorporated Intomentioning

confidence: 99%

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Management of the Febrile Young Infant

Woll

Neuman

Aronson³

2017

Pediatr Emer Care

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Infants ≤90 days of age with fever are frequently evaluated in the pediatric emergency department. Physical exam findings and individual laboratory investigations are not reliable to differentiate benign viral infections from serious bacterial infections in febrile infants. Clinical prediction models were developed over 25 years ago and have high sensitivity but relatively low specificity to identify bacterial infections in febrile infants. Newer laboratory investigations such as C-reactive protein (CRP) and procalcitonin (PCT) have favorable test characteristics compared to traditional laboratory studies such as a white blood cell count. These novel biomarkers have not gained widespread acceptance due to lack of robust prospectively collected data, varying thresholds to define positivity, and differing inclusion criteria across studies. However, CRP and PCT, when combined with other patient characteristics in the Step-by-Step approach have a high sensitivity for detection of serious bacterial infection. RNA biosignatures are a novel biomarker under investigation for detection of bacterial infection in febrile infants.

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Section: Are There New Diagnostic Tools That Can Be Incorporated Intomentioning

confidence: 99%

“…In comparison, “Lab score” was very specific but its low sensitivity limits its use as a screening test for IBI (Table 3). 42 …”

Section: Are There New Diagnostic Tools That Can Be Incorporated Intomentioning

confidence: 99%

Management of the Febrile Young Infant

Woll

Neuman

Aronson³

2017

Pediatr Emer Care

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“…Highlighting UTI as the most common bacterial infection in young febrile infants, this approach recommends evaluating age, clinical appearance and urinalysis results prior to obtaining blood samples [34]. This step‐by‐step approach has been prospectively validated and has a high sensitivity (92%) and NPV (99.3%) [35]. …”

Section: Tools For Risk Stratificationmentioning

confidence: 99%

Facing the ongoing challenge of the febrile young infant

2017

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“…Highlighting UTI as the most common bacterial infection in young febrile infants, this approach recommends evaluating age, clinical appearance and urinalysis results prior to obtaining blood samples [34]. This stepby-step approach has been prospectively validated and has a high sensitivity (92%) and NPV (99.3%) [35].…”

Section: Tools For Risk Stratificationmentioning

confidence: 99%