Risk stratification of febrile infants ≤60 days old without routine lumbar puncture

Paul L. Aronson, Marie E. Wang, Eugene D. Shapiro, Samir S. Shah, Adrienne G. DePorre, Russell J. McCulloh, Christopher M. Pruitt, Sanyukta Desai, Lise E. Nigrovic, Richard D. Marble, Rianna C. Leazer, Sahar N. Rooholamini, Laura F. Sartori, Fran Balamuth, Christopher Woll, Mark I. Neuman

Research output: Contribution to journalArticle

4 Citations (Scopus)

Abstract

OBJECTIVES: To evaluate the Rochester and modified Philadelphia criteria for the risk stratification of febrile infants with invasive bacterial infection (IBI) who do not appear ill without routine cerebrospinal fluid (CSF) testing. METHODS: We performed a case-control study of febrile infants ≤60 days old presenting to 1 of 9 emergency departments from 2011 to 2016. For each infant with IBI (defined as a blood [bacteremia] and/or CSF [bacterial meningitis] culture with growth of a pathogen), controls without IBI were matched by site and date of visit. Infants were excluded if they appeared ill or had a complex chronic condition or if data for any component of the Rochester or modified Philadelphia criteria were missing. RESULTS: Overall, 135 infants with IBI (118 [87.4%] with bacteremia without meningitis and 17 [12.6%] with bacterial meningitis) and 249 controls were included. The sensitivity of the modified Philadelphia criteria was higher than that of the Rochester criteria (91.9% vs 81.5%; P =.01), but the specificity was lower (34.5% vs 59.8%; P <.001). Among 67 infants >28 days old with IBI, the sensitivity of both criteria was 83.6%; none of the 11 low-risk infants had bacterial meningitis. Of 68 infants ≤28 days old with IBI, 14 (20.6%) were low risk per the Rochester criteria, and 2 had meningitis. CONCLUSIONS: The modified Philadelphia criteria had high sensitivity for IBI without routine CSF testing, and all infants >28 days old with bacterial meningitis were classified as high risk. Because some infants with bacteremia were classified as low risk, infants discharged from the emergency department without CSF testing require close follow-up.

Original languageEnglish (US)
Article numbere20181879
JournalPediatrics
Volume142
Issue number6
DOIs
StatePublished - Dec 2018

Fingerprint

Spinal Puncture
Fever
Bacterial Infections
Bacterial Meningitides
Cerebrospinal Fluid
Bacteremia
Meningitis
Hospital Emergency Service
Case-Control Studies

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health

Cite this

Aronson, P. L., Wang, M. E., Shapiro, E. D., Shah, S. S., DePorre, A. G., McCulloh, R. J., ... Neuman, M. I. (2018). Risk stratification of febrile infants ≤60 days old without routine lumbar puncture. Pediatrics, 142(6), [e20181879]. https://doi.org/10.1542/peds.2018-1879

Risk stratification of febrile infants ≤60 days old without routine lumbar puncture. / Aronson, Paul L.; Wang, Marie E.; Shapiro, Eugene D.; Shah, Samir S.; DePorre, Adrienne G.; McCulloh, Russell J.; Pruitt, Christopher M.; Desai, Sanyukta; Nigrovic, Lise E.; Marble, Richard D.; Leazer, Rianna C.; Rooholamini, Sahar N.; Sartori, Laura F.; Balamuth, Fran; Woll, Christopher; Neuman, Mark I.

In: Pediatrics, Vol. 142, No. 6, e20181879, 12.2018.

Research output: Contribution to journalArticle

Aronson, PL, Wang, ME, Shapiro, ED, Shah, SS, DePorre, AG, McCulloh, RJ, Pruitt, CM, Desai, S, Nigrovic, LE, Marble, RD, Leazer, RC, Rooholamini, SN, Sartori, LF, Balamuth, F, Woll, C & Neuman, MI 2018, 'Risk stratification of febrile infants ≤60 days old without routine lumbar puncture', Pediatrics, vol. 142, no. 6, e20181879. https://doi.org/10.1542/peds.2018-1879
Aronson, Paul L. ; Wang, Marie E. ; Shapiro, Eugene D. ; Shah, Samir S. ; DePorre, Adrienne G. ; McCulloh, Russell J. ; Pruitt, Christopher M. ; Desai, Sanyukta ; Nigrovic, Lise E. ; Marble, Richard D. ; Leazer, Rianna C. ; Rooholamini, Sahar N. ; Sartori, Laura F. ; Balamuth, Fran ; Woll, Christopher ; Neuman, Mark I. / Risk stratification of febrile infants ≤60 days old without routine lumbar puncture. In: Pediatrics. 2018 ; Vol. 142, No. 6.
@article{29efc372f5e34d2887aae81d492731dc,
title = "Risk stratification of febrile infants ≤60 days old without routine lumbar puncture",
abstract = "OBJECTIVES: To evaluate the Rochester and modified Philadelphia criteria for the risk stratification of febrile infants with invasive bacterial infection (IBI) who do not appear ill without routine cerebrospinal fluid (CSF) testing. METHODS: We performed a case-control study of febrile infants ≤60 days old presenting to 1 of 9 emergency departments from 2011 to 2016. For each infant with IBI (defined as a blood [bacteremia] and/or CSF [bacterial meningitis] culture with growth of a pathogen), controls without IBI were matched by site and date of visit. Infants were excluded if they appeared ill or had a complex chronic condition or if data for any component of the Rochester or modified Philadelphia criteria were missing. RESULTS: Overall, 135 infants with IBI (118 [87.4{\%}] with bacteremia without meningitis and 17 [12.6{\%}] with bacterial meningitis) and 249 controls were included. The sensitivity of the modified Philadelphia criteria was higher than that of the Rochester criteria (91.9{\%} vs 81.5{\%}; P =.01), but the specificity was lower (34.5{\%} vs 59.8{\%}; P <.001). Among 67 infants >28 days old with IBI, the sensitivity of both criteria was 83.6{\%}; none of the 11 low-risk infants had bacterial meningitis. Of 68 infants ≤28 days old with IBI, 14 (20.6{\%}) were low risk per the Rochester criteria, and 2 had meningitis. CONCLUSIONS: The modified Philadelphia criteria had high sensitivity for IBI without routine CSF testing, and all infants >28 days old with bacterial meningitis were classified as high risk. Because some infants with bacteremia were classified as low risk, infants discharged from the emergency department without CSF testing require close follow-up.",
author = "Aronson, {Paul L.} and Wang, {Marie E.} and Shapiro, {Eugene D.} and Shah, {Samir S.} and DePorre, {Adrienne G.} and McCulloh, {Russell J.} and Pruitt, {Christopher M.} and Sanyukta Desai and Nigrovic, {Lise E.} and Marble, {Richard D.} and Leazer, {Rianna C.} and Rooholamini, {Sahar N.} and Sartori, {Laura F.} and Fran Balamuth and Christopher Woll and Neuman, {Mark I.}",
year = "2018",
month = "12",
doi = "10.1542/peds.2018-1879",
language = "English (US)",
volume = "142",
journal = "Pediatrics",
issn = "0031-4005",
publisher = "American Academy of Pediatrics",
number = "6",

}

TY - JOUR

T1 - Risk stratification of febrile infants ≤60 days old without routine lumbar puncture

AU - Aronson, Paul L.

AU - Wang, Marie E.

AU - Shapiro, Eugene D.

AU - Shah, Samir S.

AU - DePorre, Adrienne G.

AU - McCulloh, Russell J.

AU - Pruitt, Christopher M.

AU - Desai, Sanyukta

AU - Nigrovic, Lise E.

AU - Marble, Richard D.

AU - Leazer, Rianna C.

AU - Rooholamini, Sahar N.

AU - Sartori, Laura F.

AU - Balamuth, Fran

AU - Woll, Christopher

AU - Neuman, Mark I.

PY - 2018/12

Y1 - 2018/12

N2 - OBJECTIVES: To evaluate the Rochester and modified Philadelphia criteria for the risk stratification of febrile infants with invasive bacterial infection (IBI) who do not appear ill without routine cerebrospinal fluid (CSF) testing. METHODS: We performed a case-control study of febrile infants ≤60 days old presenting to 1 of 9 emergency departments from 2011 to 2016. For each infant with IBI (defined as a blood [bacteremia] and/or CSF [bacterial meningitis] culture with growth of a pathogen), controls without IBI were matched by site and date of visit. Infants were excluded if they appeared ill or had a complex chronic condition or if data for any component of the Rochester or modified Philadelphia criteria were missing. RESULTS: Overall, 135 infants with IBI (118 [87.4%] with bacteremia without meningitis and 17 [12.6%] with bacterial meningitis) and 249 controls were included. The sensitivity of the modified Philadelphia criteria was higher than that of the Rochester criteria (91.9% vs 81.5%; P =.01), but the specificity was lower (34.5% vs 59.8%; P <.001). Among 67 infants >28 days old with IBI, the sensitivity of both criteria was 83.6%; none of the 11 low-risk infants had bacterial meningitis. Of 68 infants ≤28 days old with IBI, 14 (20.6%) were low risk per the Rochester criteria, and 2 had meningitis. CONCLUSIONS: The modified Philadelphia criteria had high sensitivity for IBI without routine CSF testing, and all infants >28 days old with bacterial meningitis were classified as high risk. Because some infants with bacteremia were classified as low risk, infants discharged from the emergency department without CSF testing require close follow-up.

AB - OBJECTIVES: To evaluate the Rochester and modified Philadelphia criteria for the risk stratification of febrile infants with invasive bacterial infection (IBI) who do not appear ill without routine cerebrospinal fluid (CSF) testing. METHODS: We performed a case-control study of febrile infants ≤60 days old presenting to 1 of 9 emergency departments from 2011 to 2016. For each infant with IBI (defined as a blood [bacteremia] and/or CSF [bacterial meningitis] culture with growth of a pathogen), controls without IBI were matched by site and date of visit. Infants were excluded if they appeared ill or had a complex chronic condition or if data for any component of the Rochester or modified Philadelphia criteria were missing. RESULTS: Overall, 135 infants with IBI (118 [87.4%] with bacteremia without meningitis and 17 [12.6%] with bacterial meningitis) and 249 controls were included. The sensitivity of the modified Philadelphia criteria was higher than that of the Rochester criteria (91.9% vs 81.5%; P =.01), but the specificity was lower (34.5% vs 59.8%; P <.001). Among 67 infants >28 days old with IBI, the sensitivity of both criteria was 83.6%; none of the 11 low-risk infants had bacterial meningitis. Of 68 infants ≤28 days old with IBI, 14 (20.6%) were low risk per the Rochester criteria, and 2 had meningitis. CONCLUSIONS: The modified Philadelphia criteria had high sensitivity for IBI without routine CSF testing, and all infants >28 days old with bacterial meningitis were classified as high risk. Because some infants with bacteremia were classified as low risk, infants discharged from the emergency department without CSF testing require close follow-up.

UR - http://www.scopus.com/inward/record.url?scp=85057880510&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85057880510&partnerID=8YFLogxK

U2 - 10.1542/peds.2018-1879

DO - 10.1542/peds.2018-1879

M3 - Article

C2 - 30425130

AN - SCOPUS:85057880510

VL - 142

JO - Pediatrics

JF - Pediatrics

SN - 0031-4005

IS - 6

M1 - e20181879

ER -