title: Reliability of observation variables in distinguishing infectious outcome of febrile young infants.
abstract: We prospectively evaluated 7 observation variables (level of activity, level of alertness, respiratory status/effort, peripheral perfusion, muscle tone, affect, feeding pattern) which qualify patient clinical appearance in order to determine reliability in distinguishing the infectious outcome of 233 febrile infants ages 0 to 8 weeks. Each variable was graded either 1, 3, or 5, with a higher score indicative of a greater degree of compromise. All infants received physical examination and sepsis evaluation (lumbar puncture, complete blood count/blood culture, urinalysis/urine culture). The 3 outcome groups compared were 29 cases of serious bacterial infections, (+SBI; 10 with bacterial meningitis, 12 with bacteremia, 7 with urinary tract infection), 45 cases of aseptic meningitis (AM) and 159 cases culture-negative with normal cerebrospinal fluid (CN-NCSF). The mean score for each of the 7 variables was significantly greater in the +SBI group compared with both the AM and CN-NCSF groups (P < 0.05), whereas there was no significant difference in mean score for each of the 7 variables between the AM and CN-NCSF groups. Stepwise discriminant analysis identified 3 variables that best distinguished outcome: affect; respiratory status/effort; and peripheral perfusion, which constituted the Young Infant Observation Scale. The mean total Young Infant Observation Scale score generated from assessing these 3 variables was significantly greater (P = 0.0001) in the +SBI, group (9) compared with both the AM (5) and CN-NCSF (5) groups. A total Young Infant Observation Scale score > or = 7 had a sensitivity of 76%, specificity of 75% and negative-predictive value of 96% for outcome of +SBI.
authors.affiliation: Medical College of Wisconsin, Children's Hospital of Wisconsin, Milwaukee.
authors.forename: W A
authors.initials: WA
authors.lastname: Bonadio
authors.forename: H
authors.initials: H
authors.lastname: Hennes
authors.forename: D
authors.initials: D
authors.lastname: Smith
authors.forename: R
authors.initials: R
authors.lastname: Ruffing
authors.forename: M
authors.initials: M
authors.lastname: Melzer-Lange
authors.forename: P
authors.initials: P
authors.lastname: Lye
authors.forename: D
authors.initials: D
authors.lastname: Isaacman
mesh_terms: D001424:Bacterial Infections / Q000175:diagnosis* / Q000453:epidemiology; D005334:Fever / Q000209:etiology; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008582:Meningitis, Aseptic / Q000175:diagnosis* / Q000453:epidemiology; D015588:Observer Variation; D017063:Outcome Assessment, Health Care / Q000706:statistics & numerical data*; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012803:Sick Role