OBJECTIVE: The identification of severe bacterial infection (SBI)in children with fever without source (FWS) remains a diagnostic problem. The authors previously developed in their Swiss population a risk index score, called the Lab-score, associating three independent predictors of SBI, namely C reactive protein (CRP), procalcitonin (PCT) and urinary dipstick. The objective of this study was to validate the Lab-score in a population of children with FWS different from the derivation model. METHODS: A prospective study, conducted in Padova, on 408 children aged 7 days to 36 months with FWS was recently published. PCT, CRP, white blood cell count (WBC) and urinary dipstick were determined in all children. The Lab-score was applied to this population and the diagnostic characteristics for the detection of SBI were calculated for the Lab-score and for any single variable used in the Italian study. RESULTS: For the identification of SBI, the sensitivity of a score ≥3 was 86% (95% CI 77% to 92%) and the specificity 83% (95% CI 79% to 87%). The area under the receiver operating characteristic curve for the Lab-score (0.91) was significantly superior to that of any single variable: 0.71 for WBC, 0.86 for CRP and 0.84 for PCT. The Lab-score performed better than other laboratory markers, even when applied to children of different age groups (<3 months, 3-12 months and >12 months). The results obtained in this validation set population were comparable with those of the derivation set population. CONCLUSIONS: This study validated the Lab-score as a valuable tool to identify SBI in children with FWS.
OBJECTIVE: The identification of severe bacterial infection (SBI)in children with fever without source (FWS) remains a diagnostic problem. The authors previously developed in their Swiss population a risk index score, called the Lab-score, associating three independent predictors of SBI, namely C reactive protein (CRP), procalcitonin (PCT) and urinary dipstick. The objective of this study was to validate the Lab-score in a population of children with FWS different from the derivation model. METHODS: A prospective study, conducted in Padova, on 408 children aged 7 days to 36 months with FWS was recently published. PCT, CRP, white blood cell count (WBC) and urinary dipstick were determined in all children. The Lab-score was applied to this population and the diagnostic characteristics for the detection of SBI were calculated for the Lab-score and for any single variable used in the Italian study. RESULTS: For the identification of SBI, the sensitivity of a score ≥3 was 86% (95% CI 77% to 92%) and the specificity 83% (95% CI 79% to 87%). The area under the receiver operating characteristic curve for the Lab-score (0.91) was significantly superior to that of any single variable: 0.71 for WBC, 0.86 for CRP and 0.84 for PCT. The Lab-score performed better than other laboratory markers, even when applied to children of different age groups (<3 months, 3-12 months and >12 months). The results obtained in this validation set population were comparable with those of the derivation set population. CONCLUSIONS: This study validated the Lab-score as a valuable tool to identify SBI in children with FWS.
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: Evelien de Vos-Kerkhof; Ruud G Nijman; Yvonne Vergouwe; Suzanne Polinder; Ewout W Steyerberg; Johan van der Lei; Henriëtte A Moll; Rianne Oostenbrink Journal: PLoS One Date: 2015-05-29 Impact factor: 3.240
Authors: Cristina Epalza; Marie Hallin; Laurent Busson; Sara Debulpaep; Paulette De Backer; Olivier Vandenberg; Jack Levy Journal: Clin Pediatr (Phila) Date: 2019-11-09 Impact factor: 1.168
Authors: Ruud G Nijman; Yvonne Vergouwe; Matthew Thompson; Mirjam van Veen; Alfred H J van Meurs; Johan van der Lei; Ewout W Steyerberg; Henriette A Moll; Rianne Oostenbrink Journal: BMJ Date: 2013-04-02