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In children under age three does procalcitonin help exclude serious bacterial infection in fever without focus?
  1. David Herd
  1. Children’s Emergency Department Fellow, Starship Children’s Hospital, Auckland, New Zealand; david.herd@mac.com

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A 4-month-old boy presents with a fever of 38.9°C and no focus on clinical examination. He does not appear septic and clean catch urine is normal. There are no respiratory symptoms and no clinical signs of meningitis. You think he has a low risk of a serious bacterial illness. You wonder if procalcitonin can help you exclude serious bacterial illness that may need antibiotics?

Structured clinical question

In children under three with a temperature >38.5°C and no clinical focus of infection [subject], is measurement of procalcitonin [intervention] a good screening test to exclude serious bacterial illness [outcome]?

Search strategy and outcome

Details of papers examined are given in table 1. Please see http://www.bestbets.org/cgi-bin/bets.pl?record=00597 for further information.

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Table 1

 Relevant papers

The primary source was Medline using PubMed: ((“procalcitonin”[Substance Name] OR procalcitonin[Text Word]) AND (“infant”[MeSH Terms:noexp] OR “child, preschool”[MeSH Terms])) OR ((“procalcitonin”[Substance Name] OR procalcitonin[Text Word]) AND (“Child*”)). Outcome: 127 articles (last check 13th May 2006) were found. Five studies which addressed the clinical scenario were selected. One narrative review article was found which identified four of these five papers (one was published after the review).1 Several other papers using procalcitonin for specific presentations with a fever (rash, diarrhoea) were not included.

Secondary search methods: Search replicated on Cochrane library, EMBASE, CINAHL, BestBETs, CatCrawler. Article reference lists were reviewed, and manufacturer’s website and clinical trial registers searched. No additional relevant articles were found. One systematic review on …

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