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ABSTRACT: Objectives
To assess the performance of the Yale Observation Scale (YOS) score and unstructured clinician suspicion to identify febrile infants ?60 days of age with and without serious bacterial infections (SBIs).Methods
We performed a planned secondary analysis of a prospective cohort of non-critically ill, febrile, full-term infants ?60 days of age presenting to 1 of 26 participating emergency departments in the Pediatric Emergency Care Applied Research Network. We defined SBIs as urinary tract infections, bacteremia, or bacterial meningitis, with the latter 2 considered invasive bacterial infections. Emergency department clinicians applied the YOS (range: 6-30; normal score: ?10) and estimated the risk of SBI using unstructured clinician suspicion (<1%, 1%-5%, 6%-10%, 11%-50%, or >50%).Results
Of the 4591 eligible infants, 444 (9.7%) had SBIs and 97 (2.1%) had invasive bacterial infections. Of the 4058 infants with YOS scores of ?10, 388 (9.6%) had SBIs (sensitivity: 51/439 [11.6%]; 95% confidence interval [CI]: 8.8%-15.0%; negative predictive value: 3670/4058 [90.4%]; 95% CI: 89.5%-91.3%) and 72 (1.8%) had invasive bacterial infections (sensitivity 23/95 [24.2%], 95% CI: 16.0%-34.1%; negative predictive value: 3983/4055 [98.2%], 95% CI: 97.8%-98.6%). Of the infants with clinician suspicion of <1%, 106 had SBIs (6.4%) and 16 (1.0%) had invasive bacterial infections.Conclusions
In this large prospective cohort of febrile infants ?60 days of age, neither the YOS score nor unstructured clinician suspicion reliably identified those with invasive bacterial infections. More accurate clinical and laboratory predictors are needed to risk stratify febrile infants.
SUBMITTER: Nigrovic LE
PROVIDER: S-EPMC5495524 | biostudies-literature | 2017 Jul
REPOSITORIES: biostudies-literature
Nigrovic Lise E LE Mahajan Prashant V PV Blumberg Stephen M SM Browne Lorin R LR Linakis James G JG Ruddy Richard M RM Bennett Jonathan E JE Rogers Alexander J AJ Tzimenatos Leah L Powell Elizabeth C EC Alpern Elizabeth R ER Casper T Charles TC Ramilo Octavio O Kuppermann Nathan N
Pediatrics 20170606 1
<h4>Objectives</h4>To assess the performance of the Yale Observation Scale (YOS) score and unstructured clinician suspicion to identify febrile infants ≤60 days of age with and without serious bacterial infections (SBIs).<h4>Methods</h4>We performed a planned secondary analysis of a prospective cohort of non-critically ill, febrile, full-term infants ≤60 days of age presenting to 1 of 26 participating emergency departments in the Pediatric Emergency Care Applied Research Network. We defined SBIs ...[more]