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Scientific article
English

Validation of a laboratory risk index score for the identification of severe bacterial infection in children with fever without source

Published inArchives of disease in childhood, vol. 95, no. 12, p. 968-973
Publication date2010
Abstract

OBJECTIVE: The identification of severe bacterial infection (SBI)in children with fever without source (FWS) remains a diagnostic problem. The authors previously developed in their Swiss population a risk index score, called the Lab-score, associating three independent predictors of SBI, namely C reactive protein (CRP), procalcitonin (PCT) and urinary dipstick. The objective of this study was to validate the Lab-score in a population of children with FWS different from the derivation model. METHODS: A prospective study, conducted in Padova, on 408 children aged 7 days to 36 months with FWS was recently published. PCT, CRP, white blood cell count (WBC) and urinary dipstick were determined in all children. The Lab-score was applied to this population and the diagnostic characteristics for the detection of SBI were calculated for the Lab-score and for any single variable used in the Italian study. RESULTS: For the identification of SBI, the sensitivity of a score >/=3 was 86% (95% CI 77% to 92%) and the specificity 83% (95% CI 79% to 87%). The area under the receiver operating characteristic curve for the Lab-score (0.91) was significantly superior to that of any single variable: 0.71 for WBC, 0.86 for CRP and 0.84 for PCT. The Lab-score performed better than other laboratory markers, even when applied to children of different age groups (<3 months, 3-12 months and >12 months). The results obtained in this validation set population were comparable with those of the derivation set population. CONCLUSIONS: This study validated the Lab-score as a valuable tool to identify SBI in children with FWS.

Keywords
  • Bacterial Infections/complications/*diagnosis
  • Biological Markers/blood
  • C-Reactive Protein/analysis
  • Calcitonin/blood
  • Early Diagnosis
  • Emergency Service, Hospital
  • Epidemiologic Methods
  • Female
  • Fever/*microbiology
  • Humans
  • Infant
  • Infant, Newborn
  • Leukocyte Count
  • Male
  • Protein Precursors/blood
  • Reagent Strips
  • Urinalysis/methods
Citation (ISO format)
GALETTO-LACOUR, Annick et al. Validation of a laboratory risk index score for the identification of severe bacterial infection in children with fever without source. In: Archives of disease in childhood, 2010, vol. 95, n° 12, p. 968–973. doi: 10.1136/adc.2009.176800
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ISSN of the journal0003-9888
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Creation05/23/2012 8:45:35 AM
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