Validating and updating a prediction rule for serious bacterial infection in patients with fever without source

  1. SE Bleeker1,
  2. G Derksen-Lubsen2,
  3. DE Grobbee3,
  4. ART Donders3,4,
  5. KGM Moons3,
  6. HA Moll1

Article first published online: 7 DEC 2006

DOI: 10.1111/j.1651-2227.2006.00033.x

Issue

Acta Paediatrica

Acta Paediatrica

Volume 96, Issue 1, pages 100–104, January 2007

Additional Information

How to Cite

Bleeker, S., Derksen-Lubsen, G., Grobbee, D., Donders, A., Moons, K. and Moll, H. (2007), Validating and updating a prediction rule for serious bacterial infection in patients with fever without source. Acta Paediatrica, 96: 100–104. doi: 10.1111/j.1651-2227.2006.00033.x

Author Information

  1. 1

    Erasmus Medical Center - Sophia, Department of Paediatrics, Rotterdam, The Netherlands

  2. 2

    Juliana Children's Hospital, Emergency Department, The Hague, The Netherlands

  3. 3

    Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands

  4. 4

    Center for Biostatistics, Utrecht University, The Netherlands

*Correspondence Henriëtte A Moll, Erasmus MC - Sophia, Department of Pediatrics, Room Sp 1540, P.O. Box 2060, 3000 CB Rotterdam, The Netherlands. Tel: +31 10 4636196/+31 10 4636742 | Fax: +31 10 4636685 | Email: h.a.moll@erasmusmc.nl

Publication History

  1. Issue published online: 20 DEC 2006
  2. Article first published online: 7 DEC 2006
  3. Received 16 June 2006; revised 16 June 2006; accepted 5 July 2006.

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Keywords:

  • Bacterial Infections;
  • External Validation;
  • Fever;
  • Prediction Rule;
  • Update

Abstract

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 ≥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.

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