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

Galetto-Lacour, Annick; Zamora, Samuel A.; Andreola, Barbara; Bressan, Silvia; Lacroix, Laurence Elisabeth; Da Dalt, Liviana; Gervaix, Alain

doi:10.1136/adc.2009.176800

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Title		Validation of a laboratory risk index score for the identification of severe bacterial infection in children with fever without source
Authors		Galetto-Lacour, Annick Zamora, Samuel A. Andreola, Barbara Bressan, Silvia Lacroix, Laurence Elisabeth Da Dalt, Liviana Gervaix, Alain
Published in		Archives of Disease in Childhood. 2010, vol. 95, no. 12, p. 968-973
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
Identifiers		DOI: 10.1136/adc.2009.176800 PMID: 20515973
Full text		Article - Limited access to UNIGE Other version: http://adc.bmj.com/content/95/12/968.full.pdf
Structures		Faculté de médecine / Section de médecine fondamentale / Département de neurosciences fondamentales Faculté de médecine / Section de médecine clinique / Département de pédiatrie, gynécologie et obstétrique
Research group		Etiologie des pneumonies et marqueurs inflammatoires chez l'enfant fébrile (183)
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 https://archive-ouverte.unige.ch/unige:20952