title: Markers for bacterial infection in children with fever without source.
abstract: OBJECTIVE
  To compare the diagnostic properties of procalcitonin (PCT), C reactive protein (CRP), total white blood cells count (WBC), absolute neutrophil count (ANC) and clinical evaluation to detect serious bacterial infection (SBI) in children with fever without source.
  
  
  METHODS
  Prospective cohort study.
  
  
  METHODS
  Paediatric emergency department of a tertiary care hospital.
  
  
  METHODS
  Children aged 1-36 months with fever and no identified source of infection.
  
  
  METHODS
  Complete blood count, blood culture, urine analysis and culture. PCT and CRP were also measured and SBI probability evaluated clinically with a visual analogue scale before disclosing tests results. Outcome measure Area under the curves (AUC) of the receiver operating characteristic curves.
  
  
  RESULTS
  Among the 328 children included in the study, 54 (16%) were diagnosed with an SBI: 48 urinary tract infections, 4 pneumonias, 1 meningitis and 1 bacteraemia. The AUC were similar for PCT (0.82; 95% CI 0.77 to 0.86), CRP (0.88; 95% CI 0.84 to 0.91), WBC (0.81; 95% CI 0.76 to 0.85) and ANC (0.80; 95% CI 0.75 to 0.84). The only statistically significant difference was between CRP and ANC (Δ AUC 0.08; 95% CI 0.01 to 0.16). It is important to note that all the surrogate markers were statistically superior to the clinical evaluation that had an AUC of only 0.59 (95% CI 0.54 to 0.65).
  
  
  CONCLUSIONS
  The study data demonstrate that CRP, PCT, WBC and ANC had almost similar diagnostic properties and were superior to clinical evaluation in predicting SBI in children aged 1 month to 3 years.
authors.affiliation: Department of Pediatrics, Division of Emergency Medicine, CHU Sainte-Justine, 3175 Chemin de la Côte-Ste-Catherine, Montréal, QC, Canada.
authors.forename: Sergio
authors.initials: S
authors.lastname: Manzano
authors.forename: Benoit
authors.initials: B
authors.lastname: Bailey
authors.forename: Alain
authors.initials: A
authors.lastname: Gervaix
authors.forename: Jocelyne
authors.initials: J
authors.lastname: Cousineau
authors.forename: Edgar
authors.initials: E
authors.lastname: Delvin
authors.forename: Jean-Bernard
authors.initials: JB
authors.lastname: Girodias
mesh_terms: D001424:Bacterial Infections / Q000150:complications*; D015415:Biomarkers / Q000097:blood; D002097:C-Reactive Protein / Q000032:analysis; D002116:Calcitonin / Q000097:blood; D015740:Calcitonin Gene-Related Peptide; D002675:Child, Preschool; D004636:Emergency Service, Hospital; D005260:Female; D005335:Fever of Unknown Origin / Q000382:microbiology*; D006801:Humans; D007223:Infant; D007958:Leukocyte Count; D008297:Male; D009504:Neutrophils / Q000473:pathology; D022242:Pneumococcal Vaccines; D011498:Protein Precursors / Q000097:blood; D014552:Urinary Tract Infections / Q000150:complications
chemical_list: D015415:Biomarkers; C000606589:CALCA protein, human; D022242:Pneumococcal Vaccines; D011498:Protein Precursors; D002116:Calcitonin; D002097:C-Reactive Protein; D015740:Calcitonin Gene-Related Peptide