title: Validating a decision tree for serious infection: diagnostic accuracy in acutely ill children in ambulatory care.
abstract: OBJECTIVE
  Acute infection is the most common presentation of children in primary care with only few having a serious infection (eg, sepsis, meningitis, pneumonia). To avoid complications or death, early recognition and adequate referral are essential. Clinical prediction rules have the potential to improve diagnostic decision-making for rare but serious conditions. In this study, we aimed to validate a recently developed decision tree in a new but similar population.
  
  
  METHODS
  Diagnostic accuracy study validating a clinical prediction rule.
  
  
  METHODS
  Acutely ill children presenting to ambulatory care in Flanders, Belgium, consisting of general practice and paediatric assessment in outpatient clinics or the emergency department.
  
  
  METHODS
  Physicians were asked to score the decision tree in every child.
  
  
  METHODS
  The outcome of interest was hospital admission for at least 24 h with a serious infection within 5 days after initial presentation. We report the diagnostic accuracy of the decision tree in sensitivity, specificity, likelihood ratios and predictive values.
  
  
  RESULTS
  In total, 8962 acute illness episodes were included, of which 283 lead to admission to hospital with a serious infection. Sensitivity of the decision tree was 100% (95% CI 71.5% to 100%) at a specificity of 83.6% (95% CI 82.3% to 84.9%) in the general practitioner setting with 17% of children testing positive. In the paediatric outpatient and emergency department setting, sensitivities were below 92%, with specificities below 44.8%.
  
  
  CONCLUSIONS
  In an independent validation cohort, this clinical prediction rule has shown to be extremely sensitive to identify children at risk of hospital admission for a serious infection in general practice, making it suitable for ruling out.
  
  
  BACKGROUND
  NCT02024282.
authors.affiliation: Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.
authors.forename: Jan Y
authors.initials: JY
authors.lastname: Verbakel
authors.affiliation: Department of Family Practice and Primary Health Care, Ghent University, Ghent, Belgium.
authors.forename: Marieke B
authors.initials: MB
authors.lastname: Lemiengre
authors.affiliation: Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium.
authors.forename: Tine
authors.initials: T
authors.lastname: De Burghgraeve
authors.affiliation: Department of Family Practice and Primary Health Care, Ghent University, Ghent, Belgium.
authors.forename: An
authors.initials: A
authors.lastname: De Sutter
authors.affiliation: Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium.
authors.forename: Bert
authors.initials: B
authors.lastname: Aertgeerts
authors.affiliation: Clinical Department of Paediatrics, University Hospitals Leuven, Leuven, Belgium Paediatric Immunology, Department of Microbiology and Immunology, KU Leuven, Leuven, Belgium.
authors.forename: Dominique M A
authors.initials: DM
authors.lastname: Bullens
authors.affiliation: Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.
authors.forename: Bethany
authors.initials: B
authors.lastname: Shinkins
authors.affiliation: Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.
authors.forename: Ann
authors.initials: A
authors.lastname: Van den Bruel
authors.affiliation: Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium Research Institute Caphri, Maastricht University, Maastricht, The Netherlands.
authors.forename: Frank
authors.initials: F
authors.lastname: Buntinx
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D000553:Ambulatory Care; D001530:Belgium; D002648:Child; D002675:Child, Preschool; D003661:Decision Support Techniques; D003663:Decision Trees; D005260:Female; D006801:Humans; D007223:Infant; D007239:Infections / Q000175:diagnosis*; D008297:Male; D011446:Prospective Studies; D012680:Sensitivity and Specificity
keywords: ACCIDENT & EMERGENCY MEDICINE; EPIDEMIOLOGY; PRIMARY CARE