Validating and updating a prediction rule for serious bacterial infection in patients with fever without source.
OBJECTIVE
To externally validate and update a previously developed rule for predicting the presence of serious bacterial infections in children with fever without apparent source.


METHODS
Patients, 1-36 mo, presenting with fever without source, were prospectively enrolled. Serious bacterial infection included bacterial meningitis, sepsis, bacteraemia, pneumonia, urinary tract infection, bacterial gastroenteritis, osteomyelitis/ethmoiditis. The generalizability of the original rule was determined. Subsequently, the prediction rule was updated using all available data of the patients with fever without source (1996-1998 and 2000-2001, n = 381) using multivariable logistic regression.


RESULTS
the generalizability of the rule appeared insufficient in the new patients (n = 150). In the updated rule, independent predictors from history and examination were duration of fever, vomiting, ill clinical appearance, chest-wall retractions and poor peripheral circulation (ROC area (95%CI): 0.69 (0.63-0.75)). Additional independent predictors from laboratory were serum white blood cell count and C-reactive protein, and in urinalysis > or = 70 white bloods (ROC area (95%CI): 0.83 (0.78-0.88).


CONCLUSIONS
A previously developed prediction rule for predicting the presence of serious bacterial infection in children with fever without apparent source was updated. Its clinical score can be used as a first screening tool. Additional laboratory testing may specify the individual risk estimate (range: 4-54%) further.
Bleeker
S E
SE
Erasmus Medical Center - Sophia, Department of Paediatrics, Rotterdam, The Netherlands.
Derksen-Lubsen
G
G
Grobbee
D E
DE
Donders
A R T
AR
Moons
K G M
KG
Moll
H A
HA
D001424:Bacterial Infections / Q000150:complications / Q000175:diagnosis*; D002675:Child, Preschool; D019411:Clinical Laboratory Techniques; D003661:Decision Support Techniques; D004636:Emergency Service, Hospital; D005335:Fever of Unknown Origin / Q000209:etiology*; D005544:Forecasting; D006801:Humans; D007223:Infant