A Prediction Model to Identify Febrile Infants ≤60 Days at Low Risk of Invasive Bacterial Infection

Febrile Young Infant Research Collaborative

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

OBJECTIVES: To derive and internally validate a prediction model for the identification of febrile infants ≤60 days old at low probability of invasive bacterial infection (IBI). METHODS: We conducted a case-control study of febrile infants ≤60 days old who presented to the emergency departments of 11 hospitals between July 1, 2011 and June 30, 2016. Infants with IBI, defined by growth of a pathogen in blood (bacteremia) and/or cerebrospinal fluid (bacterial meningitis), were matched by hospital and date of visit to 2 control patients without IBI. Ill-appearing infants and those with complex chronic conditions were excluded. Predictors of IBI were identified with multiple logistic regression and internally validated with 10-fold cross-validation, and an IBI score was calculated. RESULTS: We included 181 infants with IBI (155 [85.6%] with bacteremia without meningitis and 26 [14.4%] with bacterial meningitis) and 362 control patients. Twenty-three infants with IBI (12.7%) and 138 control patients (38.1%) had fever by history only. Four predictors of IBI were identified (area under the curve 0.83 [95% confidence interval (CI): 0.79-0.86]) and incorporated into an IBI score: age <21 days (1 point), highest temperature recorded in the emergency department 38.0-38.4°C (2 points) or ≥38.5°C (4 points), absolute neutrophil count ≥5185 cells per μL (2 points), and abnormal urinalysis results (3 points). The sensitivity and specificity of a score ≥2 were 98.8% (95% CI: 95.7%-99.9%) and 31.3% (95% CI: 26.3%-36.6%), respectively. All 26 infants with meningitis had scores ≥2. CONCLUSIONS: Infants ≤60 days old with fever by history only, a normal urinalysis result, and an absolute neutrophil count <5185 cells per μL have a low probability of IBI.

Original languageEnglish (US)
JournalPediatrics
Volume144
Issue number1
DOIs
StatePublished - Jul 1 2019

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Bacterial Infections
Fever
Bacterial Meningitides
Urinalysis
Confidence Intervals
Bacteremia
Meningitis
Hospital Emergency Service
Neutrophils
History
Area Under Curve
Cerebrospinal Fluid
Case-Control Studies
Cell Count
Logistic Models
Sensitivity and Specificity
Temperature
Growth

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health

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A Prediction Model to Identify Febrile Infants ≤60 Days at Low Risk of Invasive Bacterial Infection. / Febrile Young Infant Research Collaborative.

In: Pediatrics, Vol. 144, No. 1, 01.07.2019.

Research output: Contribution to journalArticle

Febrile Young Infant Research Collaborative. / A Prediction Model to Identify Febrile Infants ≤60 Days at Low Risk of Invasive Bacterial Infection. In: Pediatrics. 2019 ; Vol. 144, No. 1.
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title = "A Prediction Model to Identify Febrile Infants ≤60 Days at Low Risk of Invasive Bacterial Infection",
abstract = "OBJECTIVES: To derive and internally validate a prediction model for the identification of febrile infants ≤60 days old at low probability of invasive bacterial infection (IBI). METHODS: We conducted a case-control study of febrile infants ≤60 days old who presented to the emergency departments of 11 hospitals between July 1, 2011 and June 30, 2016. Infants with IBI, defined by growth of a pathogen in blood (bacteremia) and/or cerebrospinal fluid (bacterial meningitis), were matched by hospital and date of visit to 2 control patients without IBI. Ill-appearing infants and those with complex chronic conditions were excluded. Predictors of IBI were identified with multiple logistic regression and internally validated with 10-fold cross-validation, and an IBI score was calculated. RESULTS: We included 181 infants with IBI (155 [85.6{\%}] with bacteremia without meningitis and 26 [14.4{\%}] with bacterial meningitis) and 362 control patients. Twenty-three infants with IBI (12.7{\%}) and 138 control patients (38.1{\%}) had fever by history only. Four predictors of IBI were identified (area under the curve 0.83 [95{\%} confidence interval (CI): 0.79-0.86]) and incorporated into an IBI score: age <21 days (1 point), highest temperature recorded in the emergency department 38.0-38.4°C (2 points) or ≥38.5°C (4 points), absolute neutrophil count ≥5185 cells per μL (2 points), and abnormal urinalysis results (3 points). The sensitivity and specificity of a score ≥2 were 98.8{\%} (95{\%} CI: 95.7{\%}-99.9{\%}) and 31.3{\%} (95{\%} CI: 26.3{\%}-36.6{\%}), respectively. All 26 infants with meningitis had scores ≥2. CONCLUSIONS: Infants ≤60 days old with fever by history only, a normal urinalysis result, and an absolute neutrophil count <5185 cells per μL have a low probability of IBI.",
author = "{Febrile Young Infant Research Collaborative} and Aronson, {Paul L.} and Veronika Shabanova and Shapiro, {Eugene D.} and Wang, {Marie E.} and Nigrovic, {Lise E.} and Pruitt, {Christopher M.} and DePorre, {Adrienne G.} and Leazer, {Rianna C.} and Sanyukta Desai and Sartori, {Laura F.} and Marble, {Richard D.} and Rooholamini, {Sahar N.} and McCulloh, {Russell J.} and Christopher Woll and Fran Balamuth and Alpern, {Elizabeth R.} and Shah, {Samir S.} and Williams, {Derek J.} and Browning, {Whitney L.} and Nipam Shah and Neuman, {Mark I.}",
year = "2019",
month = "7",
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doi = "10.1542/peds.2018-3604",
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T1 - A Prediction Model to Identify Febrile Infants ≤60 Days at Low Risk of Invasive Bacterial Infection

AU - Febrile Young Infant Research Collaborative

AU - Aronson, Paul L.

AU - Shabanova, Veronika

AU - Shapiro, Eugene D.

AU - Wang, Marie E.

AU - Nigrovic, Lise E.

AU - Pruitt, Christopher M.

AU - DePorre, Adrienne G.

AU - Leazer, Rianna C.

AU - Desai, Sanyukta

AU - Sartori, Laura F.

AU - Marble, Richard D.

AU - Rooholamini, Sahar N.

AU - McCulloh, Russell J.

AU - Woll, Christopher

AU - Balamuth, Fran

AU - Alpern, Elizabeth R.

AU - Shah, Samir S.

AU - Williams, Derek J.

AU - Browning, Whitney L.

AU - Shah, Nipam

AU - Neuman, Mark I.

PY - 2019/7/1

Y1 - 2019/7/1

N2 - OBJECTIVES: To derive and internally validate a prediction model for the identification of febrile infants ≤60 days old at low probability of invasive bacterial infection (IBI). METHODS: We conducted a case-control study of febrile infants ≤60 days old who presented to the emergency departments of 11 hospitals between July 1, 2011 and June 30, 2016. Infants with IBI, defined by growth of a pathogen in blood (bacteremia) and/or cerebrospinal fluid (bacterial meningitis), were matched by hospital and date of visit to 2 control patients without IBI. Ill-appearing infants and those with complex chronic conditions were excluded. Predictors of IBI were identified with multiple logistic regression and internally validated with 10-fold cross-validation, and an IBI score was calculated. RESULTS: We included 181 infants with IBI (155 [85.6%] with bacteremia without meningitis and 26 [14.4%] with bacterial meningitis) and 362 control patients. Twenty-three infants with IBI (12.7%) and 138 control patients (38.1%) had fever by history only. Four predictors of IBI were identified (area under the curve 0.83 [95% confidence interval (CI): 0.79-0.86]) and incorporated into an IBI score: age <21 days (1 point), highest temperature recorded in the emergency department 38.0-38.4°C (2 points) or ≥38.5°C (4 points), absolute neutrophil count ≥5185 cells per μL (2 points), and abnormal urinalysis results (3 points). The sensitivity and specificity of a score ≥2 were 98.8% (95% CI: 95.7%-99.9%) and 31.3% (95% CI: 26.3%-36.6%), respectively. All 26 infants with meningitis had scores ≥2. CONCLUSIONS: Infants ≤60 days old with fever by history only, a normal urinalysis result, and an absolute neutrophil count <5185 cells per μL have a low probability of IBI.

AB - OBJECTIVES: To derive and internally validate a prediction model for the identification of febrile infants ≤60 days old at low probability of invasive bacterial infection (IBI). METHODS: We conducted a case-control study of febrile infants ≤60 days old who presented to the emergency departments of 11 hospitals between July 1, 2011 and June 30, 2016. Infants with IBI, defined by growth of a pathogen in blood (bacteremia) and/or cerebrospinal fluid (bacterial meningitis), were matched by hospital and date of visit to 2 control patients without IBI. Ill-appearing infants and those with complex chronic conditions were excluded. Predictors of IBI were identified with multiple logistic regression and internally validated with 10-fold cross-validation, and an IBI score was calculated. RESULTS: We included 181 infants with IBI (155 [85.6%] with bacteremia without meningitis and 26 [14.4%] with bacterial meningitis) and 362 control patients. Twenty-three infants with IBI (12.7%) and 138 control patients (38.1%) had fever by history only. Four predictors of IBI were identified (area under the curve 0.83 [95% confidence interval (CI): 0.79-0.86]) and incorporated into an IBI score: age <21 days (1 point), highest temperature recorded in the emergency department 38.0-38.4°C (2 points) or ≥38.5°C (4 points), absolute neutrophil count ≥5185 cells per μL (2 points), and abnormal urinalysis results (3 points). The sensitivity and specificity of a score ≥2 were 98.8% (95% CI: 95.7%-99.9%) and 31.3% (95% CI: 26.3%-36.6%), respectively. All 26 infants with meningitis had scores ≥2. CONCLUSIONS: Infants ≤60 days old with fever by history only, a normal urinalysis result, and an absolute neutrophil count <5185 cells per μL have a low probability of IBI.

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