AIM: To externally validate and update a previously developed rule for predicting the presence of serious bacterial infections in children with fever without apparent source. METHODS: Patients, 1-36 mo, presenting with fever without source, were prospectively enrolled. Serious bacterial infection included bacterial meningitis, sepsis, bacteraemia, pneumonia, urinary tract infection, bacterial gastroenteritis, osteomyelitis/ethmoiditis. The generalizability of the original rule was determined. Subsequently, the prediction rule was updated using all available data of the patients with fever without source (1996-1998 and 2000-2001, n = 381) using multivariable logistic regression. RESULTS: the generalizability of the rule appeared insufficient in the new patients (n = 150). In the updated rule, independent predictors from history and examination were duration of fever, vomiting, ill clinical appearance, chest-wall retractions and poor peripheral circulation (ROC area (95%CI): 0.69 (0.63-0.75)). Additional independent predictors from laboratory were serum white blood cell count and C-reactive protein, and in urinalysis > or = 70 white bloods (ROC area (95%CI): 0.83 (0.78-0.88). CONCLUSIONS: A previously developed prediction rule for predicting the presence of serious bacterial infection in children with fever without apparent source was updated. Its clinical score can be used as a first screening tool. Additional laboratory testing may specify the individual risk estimate (range: 4-54%) further.
AIM: To externally validate and update a previously developed rule for predicting the presence of serious bacterial infections in children with fever without apparent source. METHODS:Patients, 1-36 mo, presenting with fever without source, were prospectively enrolled. Serious bacterial infection included bacterial meningitis, sepsis, bacteraemia, pneumonia, urinary tract infection, bacterial gastroenteritis, osteomyelitis/ethmoiditis. The generalizability of the original rule was determined. Subsequently, the prediction rule was updated using all available data of the patients with fever without source (1996-1998 and 2000-2001, n = 381) using multivariable logistic regression. RESULTS: the generalizability of the rule appeared insufficient in the new patients (n = 150). In the updated rule, independent predictors from history and examination were duration of fever, vomiting, ill clinical appearance, chest-wall retractions and poor peripheral circulation (ROC area (95%CI): 0.69 (0.63-0.75)). Additional independent predictors from laboratory were serum white blood cell count and C-reactive protein, and in urinalysis > or = 70 white bloods (ROC area (95%CI): 0.83 (0.78-0.88). CONCLUSIONS: A previously developed prediction rule for predicting the presence of serious bacterial infection in children with fever without apparent source was updated. Its clinical score can be used as a first screening tool. Additional laboratory testing may specify the individual risk estimate (range: 4-54%) further.
Authors: Yvette van Ierland; Gijs Elshout; Henriëtte A Moll; Ruud G Nijman; Yvonne Vergouwe; Johan van der Lei; Marjolein Y Berger; Rianne Oostenbrink Journal: Br J Gen Pract Date: 2014-01 Impact factor: 5.386
Authors: Yvette van Ierland; Gijs Elshout; Marjolein Y Berger; Yvonne Vergouwe; Marcel de Wilde; Johan van der Lei; Henriëtte A Mol; Rianne Oostenbrink Journal: Br J Gen Pract Date: 2015-04 Impact factor: 5.386
Authors: Ruud G Nijman; Yvonne Vergouwe; Henriëtte A Moll; Frank J Smit; Floor Weerkamp; Ewout W Steyerberg; Johan van der Lei; Yolanda B de Rijke; Rianne Oostenbrink Journal: Pediatr Res Date: 2017-11-08 Impact factor: 3.756
Authors: Andrea T Cruz; Prashant Mahajan; Bema K Bonsu; Jonathan E Bennett; Deborah A Levine; Elizabeth R Alpern; Lise E Nigrovic; Shireen M Atabaki; Daniel M Cohen; John M VanBuren; Octavio Ramilo; Nathan Kuppermann Journal: JAMA Pediatr Date: 2017-11-06 Impact factor: 16.193