Nijman et al reported clinical findings associated with serious bacterial infections (SBI) in febrile children. These can help to identify a child who may require more aggressive management. The authors are from Erasmus Medical Center and Sophia's Children's Hospital, Oxford University and Haga-Juliana Children’s Hospital at the Hague.
Patient selection: febrile child or adolescent from 1 month to 15 years
Predictors of pneumonia:
(1) tachypnea
(2) oxygen saturation < 94%
(3) elevated serum CRP
Predictors of other SBIs (sepsis, meningitis, UTIs):
(1) elevated serum CRP
Exclusion of other SBIs (favor pneumonia):
(1) chest wall retactions
(2) oxygen saturation < 94%
|
Parameter |
Finding |
Points for Pneumonia |
|
age in years |
<= 1 year |
(1.02 * (age)) + (0.01 * (age)) |
|
|
> 1 year |
(0.01 * ((age) - 1) + 1.02 |
|
sex |
female |
0.13 |
|
|
male |
0 |
|
temperature °C |
|
0.29 * (temperature) |
|
fever duration in days |
|
0.21 * (days) |
|
tachypnea |
no |
0 |
|
|
yes |
0.44 |
|
tachycardia |
no |
0 |
|
|
yes |
-0.04 |
|
oxygen saturation |
>= 94% |
0 |
|
|
< 94% |
1.59 |
|
capillary refill |
<= 3 seconds |
0 |
|
|
> 3 seconds |
-0.18 |
|
chest wall retractions |
no |
0 |
|
|
yes |
0.47 |
|
ill-appearing |
no |
0 |
|
|
yes |
0.16 |
|
serum CRP in mg/L |
|
0.64 * LN(CRP) |
value of X for pneumonia =
= SUM(points) - 17.9
|
Parameter |
Finding |
Points for Pneumonia |
|
age in years |
<= 1 year |
(-1.73 * (age)) + (0.11 * (age)) |
|
|
> 1 year |
(0.11 * ((age) - 1) - 1.73 |
|
sex |
female |
0.7 |
|
|
male |
0 |
|
temperature °C |
|
-0.02 * (temperature) |
|
fever duration in days |
|
-0.03 * (days) |
|
tachypnea |
no |
0 |
|
|
yes |
-0.11 |
|
tachycardia |
no |
0 |
|
|
yes |
-0.02 |
|
oxygen saturation |
>= 94% |
0 |
|
|
< 94% |
-3.29 |
|
capillary refill |
<= 3 seconds |
0 |
|
|
> 3 seconds |
0.3 |
|
chest wall retractions |
no |
0 |
|
|
yes |
-3.78 |
|
ill-appearing |
no |
0 |
|
|
yes |
0.27 |
|
serum CRP in mg/L |
|
1.14 * LN(CRP) |
value of Y for other SBI =
= SUM(points) - 4.7
risk of pneumonia =
= EXP(X) / (1 + EXP(X) + EXP(Y))
risk of other SBI =
= EXP(Y) / (1 + EXP(X) + EXP(Y)))
Specialty: Pedatrics
