Clinical prediction model to aid emergency doctors managing febrile children at risk of serious bacterial infections: diagnostic study.
OBJECTIVE: To derive, cross validate, and externally validate a clinical prediction model that assesses the risks of different serious bacterial infections in children with fever at the emergency department. DESIGN: Prospective observational diagnostic study. SETTING: Three paediatric emergency car...
| Main Authors: | , , , , , , , , |
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| Format: | Journal article |
| Language: | English |
| Published: |
2013
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| _version_ | 1797076587031560192 |
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| author | Nijman, R Vergouwe, Y Thompson, M van Veen, M van Meurs, A van der Lei, J Steyerberg, E Moll, H Oostenbrink, R |
| author_facet | Nijman, R Vergouwe, Y Thompson, M van Veen, M van Meurs, A van der Lei, J Steyerberg, E Moll, H Oostenbrink, R |
| author_sort | Nijman, R |
| collection | OXFORD |
| description | OBJECTIVE: To derive, cross validate, and externally validate a clinical prediction model that assesses the risks of different serious bacterial infections in children with fever at the emergency department. DESIGN: Prospective observational diagnostic study. SETTING: Three paediatric emergency care units: two in the Netherlands and one in the United Kingdom. PARTICIPANTS: Children with fever, aged 1 month to 15 years, at three paediatric emergency care units: Rotterdam (n=1750) and the Hague (n=967), the Netherlands, and Coventry (n=487), United Kingdom. A prediction model was constructed using multivariable polytomous logistic regression analysis and included the predefined predictor variables age, duration of fever, tachycardia, temperature, tachypnoea, ill appearance, chest wall retractions, prolonged capillary refill time (>3 seconds), oxygen saturation <94%, and C reactive protein. MAIN OUTCOME MEASURES: Pneumonia, other serious bacterial infections (SBIs, including septicaemia/meningitis, urinary tract infections, and others), and no SBIs. RESULTS: Oxygen saturation <94% and presence of tachypnoea were important predictors of pneumonia. A raised C reactive protein level predicted the presence of both pneumonia and other SBIs, whereas chest wall retractions and oxygen saturation <94% were useful to rule out the presence of other SBIs. Discriminative ability (C statistic) to predict pneumonia was 0.81 (95% confidence interval 0.73 to 0.88); for other SBIs this was even better: 0.86 (0.79 to 0.92). Risk thresholds of 10% or more were useful to identify children with serious bacterial infections; risk thresholds less than 2.5% were useful to rule out the presence of serious bacterial infections. External validation showed good discrimination for the prediction of pneumonia (0.81, 0.69 to 0.93); discriminative ability for the prediction of other SBIs was lower (0.69, 0.53 to 0.86). CONCLUSION: A validated prediction model, including clinical signs, symptoms, and C reactive protein level, was useful for estimating the likelihood of pneumonia and other SBIs in children with fever, such as septicaemia/meningitis and urinary tract infections. |
| first_indexed | 2024-03-07T00:05:48Z |
| format | Journal article |
| id | oxford-uuid:777f7c8b-ca92-41e1-b245-b9c69b1a23cc |
| institution | University of Oxford |
| language | English |
| last_indexed | 2024-03-07T00:05:48Z |
| publishDate | 2013 |
| record_format | dspace |
| spelling | oxford-uuid:777f7c8b-ca92-41e1-b245-b9c69b1a23cc2022-03-26T20:24:26ZClinical prediction model to aid emergency doctors managing febrile children at risk of serious bacterial infections: diagnostic study.Journal articlehttp://purl.org/coar/resource_type/c_dcae04bcuuid:777f7c8b-ca92-41e1-b245-b9c69b1a23ccEnglishSymplectic Elements at Oxford2013Nijman, RVergouwe, YThompson, Mvan Veen, Mvan Meurs, Avan der Lei, JSteyerberg, EMoll, HOostenbrink, R OBJECTIVE: To derive, cross validate, and externally validate a clinical prediction model that assesses the risks of different serious bacterial infections in children with fever at the emergency department. DESIGN: Prospective observational diagnostic study. SETTING: Three paediatric emergency care units: two in the Netherlands and one in the United Kingdom. PARTICIPANTS: Children with fever, aged 1 month to 15 years, at three paediatric emergency care units: Rotterdam (n=1750) and the Hague (n=967), the Netherlands, and Coventry (n=487), United Kingdom. A prediction model was constructed using multivariable polytomous logistic regression analysis and included the predefined predictor variables age, duration of fever, tachycardia, temperature, tachypnoea, ill appearance, chest wall retractions, prolonged capillary refill time (>3 seconds), oxygen saturation <94%, and C reactive protein. MAIN OUTCOME MEASURES: Pneumonia, other serious bacterial infections (SBIs, including septicaemia/meningitis, urinary tract infections, and others), and no SBIs. RESULTS: Oxygen saturation <94% and presence of tachypnoea were important predictors of pneumonia. A raised C reactive protein level predicted the presence of both pneumonia and other SBIs, whereas chest wall retractions and oxygen saturation <94% were useful to rule out the presence of other SBIs. Discriminative ability (C statistic) to predict pneumonia was 0.81 (95% confidence interval 0.73 to 0.88); for other SBIs this was even better: 0.86 (0.79 to 0.92). Risk thresholds of 10% or more were useful to identify children with serious bacterial infections; risk thresholds less than 2.5% were useful to rule out the presence of serious bacterial infections. External validation showed good discrimination for the prediction of pneumonia (0.81, 0.69 to 0.93); discriminative ability for the prediction of other SBIs was lower (0.69, 0.53 to 0.86). CONCLUSION: A validated prediction model, including clinical signs, symptoms, and C reactive protein level, was useful for estimating the likelihood of pneumonia and other SBIs in children with fever, such as septicaemia/meningitis and urinary tract infections. |
| spellingShingle | Nijman, R Vergouwe, Y Thompson, M van Veen, M van Meurs, A van der Lei, J Steyerberg, E Moll, H Oostenbrink, R Clinical prediction model to aid emergency doctors managing febrile children at risk of serious bacterial infections: diagnostic study. |
| title | Clinical prediction model to aid emergency doctors managing febrile children at risk of serious bacterial infections: diagnostic study. |
| title_full | Clinical prediction model to aid emergency doctors managing febrile children at risk of serious bacterial infections: diagnostic study. |
| title_fullStr | Clinical prediction model to aid emergency doctors managing febrile children at risk of serious bacterial infections: diagnostic study. |
| title_full_unstemmed | Clinical prediction model to aid emergency doctors managing febrile children at risk of serious bacterial infections: diagnostic study. |
| title_short | Clinical prediction model to aid emergency doctors managing febrile children at risk of serious bacterial infections: diagnostic study. |
| title_sort | clinical prediction model to aid emergency doctors managing febrile children at risk of serious bacterial infections diagnostic study |
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