BACKGROUND: The Lab-score combining C-reactive protein (CRP), procalcitonin (PCT) and urine dipstick results has recently been derived and validated, as a good predictor of severe bacterial infections (SBI) in children with fever without a source (FWS). This easy-to-perform score might be a particularly valuable tool in the evaluation and management of well-appearing infants <3 months of age with FWS, who still represent a major diagnostic challenge in clinical practice. OBJECTIVE: To assess Lab-score usefulness in predicting SBI, as well as invasive bacterial infections (IBI) in well-appearing infants <3 months of age assessed for FWS in the pediatric emergency department (PED). DESIGN/METHODS: A multicenter retrospective study was carried out in 7 PED in Spain and Italy. An SBI was defined as isolation of a bacterial pathogen from urine, blood, cerebrospinal fluid (CSF), or stools. An IBI was defined as isolation of a bacterial pathogen from blood or CSF. According to the Lab-score 2 points were attributed to PCT≥0.5 ng/mL or CRP≥40 mg/L, 4 points to PCT≥2 ng/mL or CRP≥100 mg/L and 1 point to positive urine dipstick. RESULTS: Of the 1098 patients finally included, 290 (26.4%) had an SBI (275 urinary tract infections -12 with bacteremia) and 23 (2%) an IBI. Diagnostic accuracy measures for Lab-score cut off ≥3, as well as area under the ROC curve (AUC) for SBI and IBI are reported in Table 1. CONCLUSIONS: In well-appearing young infants with FWS the Lab-score resulted less accurate than previously reported in predicting SBI and moderately accurate in predicting IBI.

Diagnostic Performance of the Lab-Score in Predicting Severe and Invasive Bacterial Infections in Well-Appearing Febrile Young Infants.

BRESSAN, SILVIA;DA DALT, LIVIANA;
2012

Abstract

BACKGROUND: The Lab-score combining C-reactive protein (CRP), procalcitonin (PCT) and urine dipstick results has recently been derived and validated, as a good predictor of severe bacterial infections (SBI) in children with fever without a source (FWS). This easy-to-perform score might be a particularly valuable tool in the evaluation and management of well-appearing infants <3 months of age with FWS, who still represent a major diagnostic challenge in clinical practice. OBJECTIVE: To assess Lab-score usefulness in predicting SBI, as well as invasive bacterial infections (IBI) in well-appearing infants <3 months of age assessed for FWS in the pediatric emergency department (PED). DESIGN/METHODS: A multicenter retrospective study was carried out in 7 PED in Spain and Italy. An SBI was defined as isolation of a bacterial pathogen from urine, blood, cerebrospinal fluid (CSF), or stools. An IBI was defined as isolation of a bacterial pathogen from blood or CSF. According to the Lab-score 2 points were attributed to PCT≥0.5 ng/mL or CRP≥40 mg/L, 4 points to PCT≥2 ng/mL or CRP≥100 mg/L and 1 point to positive urine dipstick. RESULTS: Of the 1098 patients finally included, 290 (26.4%) had an SBI (275 urinary tract infections -12 with bacteremia) and 23 (2%) an IBI. Diagnostic accuracy measures for Lab-score cut off ≥3, as well as area under the ROC curve (AUC) for SBI and IBI are reported in Table 1. CONCLUSIONS: In well-appearing young infants with FWS the Lab-score resulted less accurate than previously reported in predicting SBI and moderately accurate in predicting IBI.
2012
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/11577/2585647
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