TY - JOUR T1 - Atoms JF - Archives of Disease in Childhood JO - Arch Dis Child SP - i LP - i DO - 10.1136/adc.2010.205773 VL - 95 IS - 12 AU - Howard Bauchner Y1 - 2010/12/01 UR - http://adc.bmj.com/content/95/12/i.abstract N2 - I remain fascinated by our continual interest in developing models to predict which children have serious bacterial infection. This saga began over 40 years ago following the publication by Teele, Pelton, and Klein that infants and young children with temperatures greater than 38°C and a white blood cell count above 15,000 have an ∼ 8-10% chance of having bacteraemia.1 Over the subsequent four decades, we have added urinary tract infection to our list of diseases of concern. During the same time period, because of the remarkable success of conjugate vaccines, bacterial meningitis has virtually disappeared. Although the “needle” in the haystack has become larger – UTIs are much more common than bacterial meningitis ever was – clearly the consequences of missing a child with a UTI pale in comparison to missing one with bacterial meningitis. Galetto-Lacour and colleagues from Italy tell us about the predictive validity of a combination of labs, C reactive protein, procalcitonin, and urinary dipstick. They pronounce the lab-score valid. However, and as is always the case, the sensitivity and specificity are not nearly perfect. In a second study, Dubos and … ER -