RT Journal Article
SR Electronic
T1 Clinical prediction models for young febrile infants at the emergency department: an international validation study
JF Archives of Disease in Childhood
JO Arch Dis Child
FD BMJ Publishing Group Ltd and Royal College of Paediatrics and Child Health
SP 1033
OP 1041
DO 10.1136/archdischild-2017-314011
VO 103
IS 11
A1 Evelien de Vos-Kerkhof
A1 Borja Gomez
A1 Karen Milcent
A1 Ewout W Steyerberg
A1 Ruud Gerard Nijman
A1 Frank J Smit
A1 Santiago Mintegi
A1 Henriette A Moll
A1 Vincent Gajdos
A1 Rianne Oostenbrink
YR 2018
UL http://adc.bmj.com/content/103/11/1033.abstract
AB Objective To assess the diagnostic value of existing clinical prediction models (CPM; ie, statistically derived) in febrile young infants at risk for serious bacterial infections.Methods A systematic literature review identified eight CPMs for predicting serious bacterial infections in febrile children. We validated these CPMs on four validation cohorts of febrile children in Spain (age <3 months), France (age <3 months) and two cohorts in the Netherlands (age 1–3 months and >3–12 months). We evaluated the performance of the CPMs by sensitivity/specificity, area under the receiver operating characteristic curve (AUC) and calibration studies.Results The original cohorts in which the prediction rules were developed (derivation cohorts) ranged from 381 to 15 781 children, with a prevalence of serious bacterial infections varying from 0.8% to 27% and spanned an age range of 0–16 years. All CPMs originally performed moderately to very well (AUC 0.60–0.93). The four validation cohorts included 159–2204 febrile children, with a median age range of 1.8 (1.2–2.4) months for the three cohorts <3 months and 8.4 (6.0–9.6) months for the cohort >3–12 months of age. The prevalence of serious bacterial infections varied between 15.1% and 17.2% in the three cohorts <3 months and was 9.8% for the cohort >3–12 months of age. Although discriminative values varied greatly, best performance was observed for four CPMs including clinical signs and symptoms, urine dipstick analyses and laboratory markers with AUC ranging from 0.68 to 0.94 in the three cohorts <3 months (ranges sensitivity: 0.48–0.94 and specificity: 0.71–0.97). For the >3–12 months’ cohort AUC ranges from 0.80 to 0.89 (ranges sensitivity: 0.70–0.82 and specificity: 0.78–0.90). In general, the specificities exceeded sensitivities in our cohorts, in contrast to derivation cohorts with high sensitivities, although this effect was stronger in infants <3 months than in infants >3–12 months.Conclusion We identified four CPMs, including clinical signs and symptoms, urine dipstick analysis and laboratory markers, which can aid clinicians in identifying serious bacterial infections. We suggest clinicians should use CPMs as an adjunctive clinical tool when assessing the risk of serious bacterial infections in febrile young infants.