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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
medicine
Predicting risk of serious bacterial infections in febrile children in the emergency department
Pediatrics, Volume 140, No. 2, Article e20162853, Year 2017
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Description
BACKGROUND: Improving the diagnosis of serious bacterial infections (SBIs) in the children's emergency department is a clinical priority. Early recognition reduces morbidity and mortality, and supporting clinicians in ruling out SBIs may limit unnecessary admissions and antibiotic use. METHODS: A prospective, diagnostic accuracy study of clinical and biomarker variables in the diagnosis of SBIs (pneumonia or other SBI) in febrile children <16 years old. A diagnostic model was derived by using multinomial logistic regression and internally validated. External validation of a published model was undertaken, followed by model updating and extension by the inclusion of procalcitonin and resistin. RESULTS: There were 1101 children studied, of whom 264 had an SBI. A diagnostic model discriminated well between pneumonia and no SBI (concordance statistic 0.84, 95% confidence interval 0.78-0.90) and between other SBIs and no SBI (0.77, 95% confidence interval 0.71-0.83) on internal validation. A published model discriminated well on external validation. Model updating yielded good calibration with good performance at both high-risk (positive likelihood ratios: 6.46 and 5.13 for pneumonia and other SBI, respectively) and low-risk (negative likelihood ratios: 0.16 and 0.13, respectively) thresholds. Extending the model with procalcitonin and resistin yielded improvements in discrimination. CONCLUSIONS: Diagnostic models discriminated well between pneumonia, other SBIs, and no SBI in febrile children in the emergency department. Improvements in the classification of nonevents have the potential to reduce unnecessary hospital admissions and improve antibiotic prescribing. The benefits of this improved risk prediction should be further evaluated in robust impact studies. © 2017 by the American Academy of Pediatrics.
Authors & Co-Authors
Irwin, Adam D.
United Kingdom, Liverpool
University of Liverpool
United Kingdom, London
Great Ormond Street Hospital for Children Nhs Foundation Trust
Kolamunnage-Dona, Ruwanthi
United Kingdom, Liverpool
University of Liverpool
Drew, R. J.
Ireland, Dublin
The Rotunda Hospital Dublin
Ireland, Dublin
Royal College of Surgeons in Ireland
Paulus, Stéphane C.
United Kingdom, Liverpool
Alder Hey Children's Nhs Foundation Trust
Jeffers, Graham
United Kingdom, Liverpool
University of Liverpool
Preston, Jennifer
United Kingdom, Liverpool
University of Liverpool
Appelbe, Duncan E.
United Kingdom, Liverpool
University of Liverpool
Chesters, Christine A.
United Kingdom, Liverpool
Alder Hey Children's Nhs Foundation Trust
Newland, Paul
United Kingdom, Liverpool
Alder Hey Children's Nhs Foundation Trust
McNamara, Paul Stephen
United Kingdom, Liverpool
University of Liverpool
Diggle, Peter J.
United Kingdom, Liverpool
University of Liverpool
United Kingdom, Lancaster
Lancaster University
Carrol, Enitan D.
United Kingdom, Liverpool
University of Liverpool
Statistics
Citations: 55
Authors: 12
Affiliations: 6
Identifiers
Doi:
10.1542/peds.2016-2853
ISSN:
00314005
Research Areas
Health System And Policy
Maternal And Child Health
Study Design
Cohort Study