title: Clinical prediction model to aid emergency doctors managing febrile children at risk of serious bacterial infections: diagnostic study.
abstract: OBJECTIVE
  To derive, cross validate, and externally validate a clinical prediction model that assesses the risks of different serious bacterial infections in children with fever at the emergency department.
  
  
  METHODS
  Prospective observational diagnostic study.
  
  
  METHODS
  Three paediatric emergency care units: two in the Netherlands and one in the United Kingdom.
  
  
  METHODS
  Children with fever, aged 1 month to 15 years, at three paediatric emergency care units: Rotterdam (n=1750) and the Hague (n=967), the Netherlands, and Coventry (n=487), United Kingdom. A prediction model was constructed using multivariable polytomous logistic regression analysis and included the predefined predictor variables age, duration of fever, tachycardia, temperature, tachypnoea, ill appearance, chest wall retractions, prolonged capillary refill time (>3 seconds), oxygen saturation <94%, and C reactive protein.
  
  
  METHODS
  Pneumonia, other serious bacterial infections (SBIs, including septicaemia/meningitis, urinary tract infections, and others), and no SBIs.
  
  
  RESULTS
  Oxygen saturation <94% and presence of tachypnoea were important predictors of pneumonia. A raised C reactive protein level predicted the presence of both pneumonia and other SBIs, whereas chest wall retractions and oxygen saturation <94% were useful to rule out the presence of other SBIs. Discriminative ability (C statistic) to predict pneumonia was 0.81 (95% confidence interval 0.73 to 0.88); for other SBIs this was even better: 0.86 (0.79 to 0.92). Risk thresholds of 10% or more were useful to identify children with serious bacterial infections; risk thresholds less than 2.5% were useful to rule out the presence of serious bacterial infections. External validation showed good discrimination for the prediction of pneumonia (0.81, 0.69 to 0.93); discriminative ability for the prediction of other SBIs was lower (0.69, 0.53 to 0.86).
  
  
  CONCLUSIONS
  A validated prediction model, including clinical signs, symptoms, and C reactive protein level, was useful for estimating the likelihood of pneumonia and other SBIs in children with fever, such as septicaemia/meningitis and urinary tract infections.
authors.affiliation: Department of General Paediatrics, Erasmus MC-Sophia Children's Hospital, 3015 GJ Rotterdam, Netherlands.
authors.forename: Ruud G
authors.initials: RG
authors.lastname: Nijman
authors.forename: Yvonne
authors.initials: Y
authors.lastname: Vergouwe
authors.forename: Matthew
authors.initials: M
authors.lastname: Thompson
authors.forename: Mirjam
authors.initials: M
authors.lastname: van Veen
authors.forename: Alfred H J
authors.initials: AH
authors.lastname: van Meurs
authors.forename: Johan
authors.initials: J
authors.lastname: van der Lei
authors.forename: Ewout W
authors.initials: EW
authors.lastname: Steyerberg
authors.forename: Henriette A
authors.initials: HA
authors.lastname: Moll
authors.forename: Rianne
authors.initials: R
authors.lastname: Oostenbrink
mesh_terms: D000293:Adolescent; D001424:Bacterial Infections / Q000175:diagnosis*; D002097:C-Reactive Protein / Q000032:analysis; D002648:Child; D002675:Child, Preschool; D004630:Emergencies; D004636:Emergency Service, Hospital; D005260:Female; D005334:Fever / Q000382:microbiology*; D006801:Humans; D007223:Infant; D008297:Male; D015233:Models, Statistical; D011379:Prognosis; D011446:Prospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index
chemical_list: D002097:C-Reactive Protein
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