Febrile young infants with abnormal urine dipstick at low risk of invasive bacterial infection - Velasco, R.; Lejarzegi, A.; Gomez, B.; de la Torre, M.; Duran, I.; Camara, A.; de la Rosa, D.; Manzano, S.; Rodriguez, J.; Gonzalez, A.; Lopes, A. A.; Rivas, A.; et al. (Arch Dis Child, 2020)
OBJECTIVES: To develop and validate a prediction rule to identify well-appearing febrile infants aged </=90 days with an abnormal urine dipstick at low risk of invasive bacterial infections (IBIs, bacteraemia or bacterial meningitis). DESIGN: Ambispective, multicentre study. SETTING: The derivation set in a single paediatric emergency department (ED) between 2003 and 2017. The validation set in 21 European EDs between December 2017 and November 2019. PATIENTS: Two sets of well-appearing febrile infants aged </=90 days with an abnormal urine dipstick (either leucocyte esterase and/or nitrite positive test). MAIN OUTCOME: Prevalence of IBI in low-risk infants according to the RISeuP score. RESULTS: We included 662 infants in the derivation set (IBI rate:5.2%). After logistic regression, we developed a score (RISeuP score) including age (</=15 days old), serum procalcitonin (>/=0.6 ng/mL) and C reactive protein (>/=20 mg/L) as risk factors. The absence of any risk factor had a sensitivity of 96.0% (95% CI 80.5% to 99.3%), a negative predictive value of 99.4% (95% CI 96.4% to 99.9%) and a specificity of 32.9% (95% CI 28.8% to 37.3%) for ruling out an IBI. Applying it in the 449 infants of the validation set (IBI rate 4.9%), sensitivity, negative predictive value and specificity were 100% (95% CI 87.1% to 100%), 100% (95% CI 97.3% to 100%) and 29.7% (95% CI 25.8% to 33.8%), respectively. CONCLUSION: This prediction rule accurately identified well-appearing febrile infants aged </=90 days with an abnormal urine dipstick at low risk of IBI. This score can be used to guide initial clinical decision-making in these patients, selecting infants suitable for an outpatient management.
Keywords: journalArticle; *Fever/etiology; *Urinalysis/methods; Bacteremia/diagnosis/epidemiology/urine; Bacterial Infections/diagnosis/urine/epidemiology; C-Reactive Protein/analysis; Clinical Decision Rules; Emergency Service, Hospital; Female; Humans; Infant; Infant, Newborn; Male; Meningitis, Bacterial/diagnosis/epidemiology/urine; Predictive Value of Tests; Risk Assessment/methods; Risk Factors; Sensitivity and Specificity; microbiology; neonatology; nephrology