1. Validation of a laboratory risk score for the identification of severe bacterial infection in children with fever without source
Galetto-Lacour A, Zamora S, Andreola B, Bressan S, Lacroix L, Da Dalt L and Gervaix A Arch Dis Child 2010; 95:
Dr Vanessa Craven

2. Procalcitonin

3. Brunkhorst FM et al. Intens. Care Med 1998; 24: 888-892

4. Pediatr Infect Dis J 2008; 27: 654-6
202  months
Rectal temp >38°C & no focus
IOS
Urine MC&S
WCC, CRP & PCT
LP ‘when meningitis suspected’
Clinical follow up within 48 hours

5. Results SBI 54 (27%) PCT: OR 37.6 (5.8 - 243) CRP: OR 7.8 (2 - 30.4)
Urine dipstick: OR 23.2 ( )

6. Predictor
Points
PCT (ng/ml)
< 0.5
≥ 0.5
≥ 2.0 2 4
CRP (mg/ml)
< 40
40-99
≥ 100
Urine dipstick
Negative
Positive 1

7. AIM External validation More children 2007 Italian population
Laboratory score ≥ 3

8. Methodology Prospective enrolment - 408 children
Data from Italian study
May October 2005
7 days (>38C) to 36 months (>39.5°C)

9. 7 days to 36 months
Fever without source
Exclusion criteria
Looking for severe bacterial infection (defined) – diagnosis ‘at end of follow up’
SBI vs ‘benign viral infection’
Retrospective (5 years)
Using another study’s cohort

10. Reasonable age definition & exclusion criteria
Using another study’s data set
Higher temperature cut off than used in practice?

11. Laboratory measurements
Who confirmed FWS?
ALL were assessed at 72 hours (including telephone contact) – no details
Cultures would be back but not always reliable
What happened to the classification of children that did not improve? Or had focal infection and did not get Abx
DMSA to diagnose pyleonephritis (1/52)

12. Who did the assessments?
Who followed up?

13. ALL were followed up
No details about
- follow up length
- location
Was 72 hr review conclusive in all
Any need Abx/admission
What happened to the ‘focal bacterial infection’ 15.8%?

14. SBI in 92 (22.7%)
Score ≥3: Sens 86% (77-92%)
Spec: 83% (79-87%)
Sens ↑and spec ↓ with age
WBC: Sens 52%, Spec 75%
CRP: Sens 52%, Spec 75%
PCT: Sens 75%, Spec 76%
Missed 13 cases
Very large confidence intervals!
Large confidence intervals
Selected population

15. BUT referral pathway different
WCC poor predictor
Pediatr Infect Dis J 2008; 27: 654-6
Results comparable to derivation set

16. Summary & Conclusion
There is insufficient evidence to support the sole use of the lab score to identify those with severe bacterial infection