Background and aims C-reactive protein and Procalcitonin have been lately the most researched biomarkers in identifying serious bacterial infections (SBI) in febrile children. The Lab-score (2008) includes CRP, PCT and urinalysis for detecting SBI and the Clinical Prediction Model (CPM) (2013) combines clinical variables with CRP value for detecting pneumonia and other SBI separately. We aimed to assess and compare the value of the Lab-score and the CPM in identifying febrile children at risk for SBI in the Emergency Department (ED).
Method This survey is part of a prospective observational study aimed to identify children with fever without source at risk for SBI. Patients were recruited from Tirgu Mures Emergency Clinical County Hospital, Romania. SBI diagnosis was based on urine, blood and CSF cultures and chest radiographs. For children included, aged 1 to 36 months, the Lab-score and the CPM were calculated. Positive and negative likelihood ratios and post test probabilities were calculated for each test.
Results From 134 children, SBI was diagnosed in 31 (23.13%): 11 pneumonia and 20 other SBI, mostly urinary tract infections. Positive and negative likelihood ratios for Lab-score (≥3), CPM-Pneumonia (≥10%) and CPM-Other SBI (≥10%) were 7,25/0,25, 22/0,65 and 5,23/0,50 and the post test probabilities were 69%, 66% and 48% for the same cut-off values.
Conclusions Both the Lab-score and CPM-Pneumonia are valuable tools in detecting SBI in febrile young children. CPM-Other SBI showed less performance than Lab-score and CPM-Pneumonia, possibly due to the lack of urinalysis value in CPM-Other SBI, which are mostly UTI.