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  • Title: Febrile young infants with abnormal urine dipstick at low risk of invasive bacterial infection.
    Author: Velasco R, Lejarzegi A, Gomez B, de la Torre M, Duran I, Camara A, de la Rosa D, Manzano S, Rodriguez J, González A, Lopes AA, Rivas A, Martinez I, Angelats CM, Moya S, Corral S, Alonso J, Del Rio P, Sancho E, Ruiz Del Olmo I, Nieto I, Vega B, Mintegi S, Research in European Pediatric Emergency Medicine (REPEM) and the Spanish Pediatric Emergency Research Group (RISeuP-SPERG).
    Journal: Arch Dis Child; 2021 Jul 19; 106(8):758-763. PubMed ID: 33246922.
    Abstract:
    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.
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