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Risk score to stratify children with suspected serious bacterial infection: observational cohort study
  1. Andrew J Brent1,2,
  2. Monica Lakhanpaul1,3,
  3. Matthew Thompson1,4,5,
  4. Jacqueline Collier1,6,
  5. Samiran Ray7,
  6. Nelly Ninis1,2,
  7. Michael Levin1,2,
  8. Roddy MacFaul1,8
  1. 1Royal College of Paediatrics and Child Health (RCPCH) Working Group on Recognising Acute Illness in Children, London, UK
  2. 2Department of Paediatrics, Imperial College London, London, UK
  3. 3Department of Medical Education and Social Care, University of Leicester, Leicester, UK
  4. 4Oxford University Department of Primary Health Care, Institute of Health Sciences, Oxford, UK
  5. 5Department of Family Medicine, Oregon Health & Science University, Portland, Oregon, USA
  6. 6Centre for Population Sciences, University of Nottingham, Nottingham, UK
  7. 7Paediatric Intensive Care Unit, Great Ormond Street Hospital, London, UK
  8. 8Paediatric Department, Pinderfields Hospital, Wakefield, UK
  1. Correspondence to Dr Andrew J Brent, KEMRI-Wellcome Trust Research Programme, PO Box 230, 80108 Kilifi, Kenya; dr.a.brent{at}


Objectives To derive and validate a clinical score to risk stratify children presenting with acute infection.

Study design and participants Observational cohort study of children presenting with suspected infection to an emergency department in England. Detailed data were collected prospectively on presenting clinical features, laboratory investigations and outcome. Clinical predictors of serious bacterial infection (SBI) were explored in multivariate logistic regression models using part of the dataset, each model was then validated in an independent part of the dataset, and the best model was chosen for derivation of a clinical risk score for SBI. The ability of this score to risk stratify children with SBI was then assessed in the entire dataset.

Main outcome measure Final diagnosis of SBI according to criteria defined by the Royal College of Paediatrics and Child Health working group on Recognising Acute Illness in Children.

Results Data from 1951 children were analysed. 74 (3.8%) had SBI. The sensitivity of individual clinical signs was poor, although some were highly specific for SBI. A score was derived with reasonable ability to discriminate SBI (area under the receiver operator characteristics curve 0.77, 95% CI 0.71 to 0.83) and risk stratify children with suspected SBI.

Conclusions This study demonstrates the potential utility of a clinical score in risk stratifying children with suspected SBI. Further work should aim to validate the score and its impact on clinical decision making in different settings, and ideally incorporate it into a broader management algorithm including additional investigations to further stratify a child's risk.

This paper is freely available online under the BMJ Journals unlocked scheme, see

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  • Funding AJB is supported by a Wellcome Trust research training fellowship (081697). The authors wish to thank the Well Child Medical Charity for their funding of the studies in Nottingham and of this study.

  • Competing interests None.

  • Ethics approval This study was conducted with the approval of the Nottingham Research Ethics Committee and the ethics committee of the London School of Hygiene and Tropical Medicine.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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