Hagedoorn et al reported a model for predicting an invasive bacterial infection in a febrile child. The predicted risk of an invasive bacterial infection can help to decide whether or not to start intravenous antibiotics. The authors are from multiple institutions in Europe.
Patient selection:<= 18 years of age, temperature >= 38.0°C
Sources of items: Feverkidstool, NICE warning signs, comorbidity
Parameters:
(1) sex of the patient
(2) age of the patient in years
(3) temperature in °C (truncated at 35.7 if below)
(4) fever duration in days (truncated at 8 days)
(5) tachypnea (from Advanced Pediatric Life Support)
(6) tachycardia (from Advanced Pediatric Life Support)
(7) hypoxia (oxygen saturation < 94%)
(8) increased work of breathing
(9) ill-appearance
(10) serum CRP in mg/L (truncated at 215 mg/L)
(11) abnormal neurology
(12) non-blanching rash
(13) complex chronic condition (comorbidity; >= 2 body systems affected, malignancy or immunocompromised)
|
Parameter
|
Finding
|
Beta-Coefficient
|
|
sex of the patient
|
female
|
0
|
|
|
male
|
-0.19
|
|
age of the patient
|
< 1 year
|
-2.53 * (years)
|
|
|
>= 1 year
|
-2.53
|
|
temperature
|
|
-0.05 * (temperature)
|
|
fever duration
|
|
-0.15 * (days)
|
|
tachypnea
|
no
|
0
|
|
|
yes
|
-0.44
|
|
tachycardia
|
no
|
0
|
|
|
yes
|
0.69
|
|
hypoxia
|
no
|
0
|
|
|
yes
|
-0.87
|
|
increased work of breathing
|
no
|
0
|
|
|
yes
|
-0.31
|
|
ill appearing
|
no
|
0
|
|
|
yes
|
0.87
|
|
serum CRP
|
|
0.76 * LN(CRP)
|
|
abnormal neurology
|
no
|
0
|
|
|
yes
|
1.54
|
|
non-blanching rash
|
no
|
0
|
|
|
yes
|
1.38
|
|
comorbidity
|
no
|
0
|
|
|
yes
|
2.41
|
where:
• The handling of age is according to the footnote to Table 2.
total score =
= SUM(beta coefficients for all of the parameters) - 9.16
probability of an invasive bacterial infection =
= 1 / (1 + EXP((-1) * X))
Interpretation:
• A predicted risk> 2% can be used as a trigger to start intravenous antibiotics.
