Summary
Parents frequently bring their children to the Emergency Department (ED) because of the fever without apparent source (FWAS). To avoid possible complications, it is important to recognize serious bacterial infection (SBI) as early as possible. Various tests, including different clinical scores and scales, are used in the laboratory evaluation of patients. However, it is still impossible to predict the presence of SBI with complete certainty. Galetto-Lacour et al. developed and validated a risk index score, named Lab-score. Lab-score is based on the three predictive variables independently associated with SBI: procalcitonin (PCT), C-reactive protein (CRP), and urinary dipstick. The objective of this study was to assess the performance of the Lab-score in predicting SBI in well-appearing infants ≤ 180 days of age with FWAS, who presented to ED and were hospitalized with suspicion of having SBI. Based on this study findings, white blood cells count (WBC), CRP, PCT, and lab-score ≥ 3 were confirmed as useful biomarkers for differentiation between SBI and non-SBI. Also, receiver operating characteristic curve (ROC) analysis confirmed that all of them were useful for differentiation between SBI and non-SBI patients with the highest area under curve (AUC) calculated for the Lab-score. The results of this research confirmed its value, with calculated sensitivity of 67.7 % and specificity of 98.6 % in prediction of SBI in infants aged ≤ 180 days. Its value was even better in infants aged ≤ 90 days with sensitivity of 75 % and specificity of 97.7 %. In conclusion, we demonstrated the high value of lab-score in detecting SBI in infants under 6 months of age with FWAS.
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References
Baraff L, Bass J, Fleisher G, et al. Practice guideline for the management of infants and children 0 to 36 months of age with fever without source. Pediatrics. 1993;92(1):1–12.
Vorwerk C, Manias K, Davies F, Coats T. Prediction of severe bacterial infection in children with an emergency department diagnosis of infection. Emerg Med J. 2011;28(11):948–51.
Bachur R, Harper M. Predictive model for serious bacterial infections among infants younger than 3 months of age. Pediatrics. 2001;108(2):311–6.
Trautner B, Caviness A, Gerlacher G, Demmler G, Macias C. Prospective evaluation of the risk of serious bacterial infection in children who present to the emergency department with hyperpyrexia (temperature of 106 degrees F or higher). Pediatrics. 2006;118(1):34–40.
Hoffmann J. Neutrophil CD64: a diagnostic marker for infection and sepsis. Clin Chem Lab Med. 2009;47(8):903–16.
Ashkenazi-Hoffnung L, Livni G, Amir J, Bilavsky E. Serious bacterial infections in hospitalized febrile infants aged 90 days or younger: The traditional combination of ampicillin and gentamicin is still appropriate. Scand J Infect Dis. 2011;43(6–7):489–94.
Huppler AR, Eickhoff JC, Wald ER. Performance of low-risk criteria in the evaluation of young infants with fever: review of the literature. Pediatrics. 2010;125(2):228–33.
Bilavsky E, Yarden-Bilavsky H, Ashkenazi S, Amir J. C-reactive protein as a marker of serious bacterial infections in hospitalized febrile infants. Acta Paediatr. 2009;98(11):1776–80.
Olaciregui I, Hernandez U, Munoz J, Emparanza J, Landa J. Markers that predict serious bacterial infection in infants under 3 months of age presenting with fever of unknown origin. Arch Dis Child. 2009;94(7):501–5.
Andreola B, Bressan S, Callegaro S, Liverani A, Plebani M, Da Dalt L. Procalcitonin and C-reactive protein as diagnostic markers of severe bacterial infections in febrile infants and children in the emergency department. Pediatr Infect Dis J. 2007;26(8):672–7.
Dagan R, Sofer S, Phillip M, Shachak E. Ambulatory care of febrile infants younger than 2 months of age classified as being at low-risk for having serious bacterial-infections. J Pediatr. 1988;112(3):355–60.
Baker M, Bell L, Avner J. Outpatient management without antibiotics of fever in selected infants. N Engl J Med. 1993;329(20):1437–41.
Markic J, Jeroncic A, Polancec D, et al. CD15s is a potential biomarker of serious bacterial infection in infants admitted to hospital. Eur J Pediatr. 2013;172(10):1363–9.
Committee ACoEPCP, Fever. ACoEPCPSoP. Clinical policy for children younger than three years presenting to the emergency department with fever. Ann Emerg Med. 2003;42(4):530–45.
Jaskiewicz J, McCarthy C, Richardson A, et al. Febrile infants at low-risk for serious bacterial-infection—An appraisal of the Rochester criteria and implications for management. Pediatrics. 1994;94(3):390–6.
Lacour A, Zamora S, Gervaix A. A score identifying serious bacterial infections in children with fever without source. Pediatr Infect Dis J. 2008;27(7):654–6.
Galetto-Lacour A, Zamora SA, Andreola B, et al. Validation of a laboratory risk index score for the identification of severe bacterial infection in children with fever without source. Arch Dis Child. 2010;95(12):968–73.
Bressan S, Gomez B, Mintegi S, et al. Diagnostic performance of the lab-score in predicting severe and invasive bacterial infections in well-appearing young febrile infants. Pediatr Infect Dis J. 2012;31(12):1239–44.
Pearson G, editor. Why children die: a pilot study 2006; England (South West, North East and West Midlands), Wales and Northern Ireland. London: CEMACH; 2008.
Ng P, Lam H. Diagnostic markers for neonatal sepsis. Curr Opin Pediatr. 2006;18(2):125–31.
Hui C, Neto G, Tsertsvadze A, et al. Diagnosis and management of febrile infants (0–3 months). Evid Rep Technol Assess (Full Rep). 2012(205):1–297.
Lacour A, Gervaix A, Zamora S, et al. Procalcitonin, IL-6, IL-8, IL-1 receptor antagonist and C-reactive protein as identificators of serious bacterial infections in children with fever without localising signs. Eur J Pediatr. 2001;160(2):95–100.
Galetto-Lacour A, Zamora S, Gervaix A. Bedside procalcitonin and C-reactive protein tests in children with fever without localizing signs of infection seen in a referral center. Pediatrics. 2003;112(5):1054–60.
Hsiao A, Chen L, Baker M. Incidence and predictors of serious bacterial infections among 57-to 180-day-old infants. Pediatrics. 2006;117(5):1695–701.
Sanders S, Barnett A, Correa-Velez I, Coulthard M, Doust J. Systematic review of the diagnostic accuracy of C-reactive protein to detect bacterial infection in nonhospitalized infants and children with fever. J Pediatr. 2008;153(4):570–4.
Yo CH, Hsieh PS, Lee SH, et al. Comparison of the test characteristics of procalcitonin to C-reactive protein and leukocytosis for the detection of serious bacterial infections in children presenting with fever without source: a systematic review and meta-analysis. Ann Emerg Med. 2012;60(5):591–600.
Rudensky B, Sirota G, Erlichman M, Yinnon A, Schlesinger Y. Neutrophil CD64 expression as a diagnostic marker of bacterial infection in febrile children presenting to a Hospital Emergency Department. Pediatr Emerg Care. 2008;24(11):745–8.
Hodge G, Hodge S, Han P, Haslam R. Multiple leucocyte activation markers to detect neonatal infection. Clin Exp Immunol. 2004;135(1):125–9.
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Markic, J., Kovacevic, T., Krzelj, V. et al. Lab-score is a valuable predictor of serious bacterial infection in infants admitted to hospital. Wien Klin Wochenschr 127, 942–947 (2015). https://doi.org/10.1007/s00508-015-0831-6
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DOI: https://doi.org/10.1007/s00508-015-0831-6