Abstract
Background
To validate the Feverkidstool, a prediction model consisting of clinical signs and symptoms and C-reactive protein (CRP) to identify serious bacterial infections (SBIs) in febrile children, and to determine the incremental diagnostic value of procalcitonin.
Methods
This prospective observational study that was carried out at two Dutch emergency departments included children with fever, aged 1 month to 16 years. The prediction models were developed with polytomous logistic regression differentiating “pneumonia” and “other SBIs” from “non-SBIs” using standardized, routinely collected data on clinical signs and symptoms, CRP, and procalcitonin.
Results
A total of 1,085 children were included with a median age of 1.6 years (interquartile range 0.8–3.4); 73 children (7%) had pneumonia and 98 children (9%) had other SBIs. The Feverkidstool showed good discriminative ability in this new population. After adding procalcitonin to the Feverkidstool, c-statistic for “pneumonia” increased from 0.85 (95% confidence interval (CI) 0.76–0.94) to 0.86 (0.77–0.94) and for “other SBI” from 0.81 (0.73–0.90) to 0.83 (0.75– 0.91). A model with clinical features and procalcitonin performed similar to the Feverkidstool.
Conclusion
This study confirms the external validity of the Feverkidstool, with CRP and procalcitonin being equally valuable for predicting SBI in our population of febrile children. Our findings do not support routine dual use of CRP and procalcitonin.
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Acknowledgements
We thank Barry Koelewijn, Sascha Smit, members of the point of care testing team of the Erasmus MC—Sophia Children’s Hospital, and all nurses at both study sites for their valuable contributions to the study. Moreover, we acknowledge Marjolein Neele for contributing to the data collection and for analyzing the laboratory samples at the Maasstad hospital. We thank Evelien Kerkhof for supporting data collection and defining final diagnoses. Finally, we acknowledge Marcel de Wilde for designing the electronic data entry forms at the Erasmus MC. None had access to the data or received additional financial compensation. The Afinion AS100 analyzer and Afinion AS100 C-Reactive Protein bedside kits were provided by Axis-Shield PoC AS, Norway, and were distributed by Clindia Benelux BV. The procalcitonin kits were supplied by Brahms.
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All authors substantially contributed to the writing (i.e., drafting and/or critical revision) of the manuscript. R.G.N. is the main author of the paper and was involved in development and implementation of the study’s protocol, data acquisition, patient inclusion, and data analysis. H.A.M. contributed to obtaining funding for the study, protocol development, and data collection and monitoring. Y.V. was responsible for statistical analyses and interpretation of the results. F.J.S. was responsible for protocol development, data collection, and study implementation. F.W. was responsible for analyzing laboratory samples and data collection. E.W.S. contributed to obtaining funding, protocol development, statistical analyses, and interpretation of the results. J.v.d.L. contributed to obtaining funding and protocol development, supervising the data collection and monitoring, and providing technical support. Y.B.d.R. was involved in protocol development, laboratory analysis, and data collection. R.O. was mainly responsible for obtaining funding for the study, supervised the research project, and was responsible for protocol development, data collection, and interpretation of the results. All authors have read and approved the final version of the manuscript; R.G.N. and R.O. had full access to all data and take responsibility for the integrity of the data and accuracy of the data analysis.
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R.G.N. is supported by ZonMW, a Dutch organization for health research and development, and Erasmus MC Doelmatigheid; Y.V. is funded by the Netherlands Organization for Scientific Research (Grant 917.11.383); and R.O. is supported by a fellowship grant of the European Society of Pediatric Infectious Diseases in 2010.
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Neither funding sources, nor Axis-Shield PoC AS, Clindia Benelux BV, or Brahms were involved in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.
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Nijman, R., Vergouwe, Y., Moll, H. et al. Validation of the Feverkidstool and procalcitonin for detecting serious bacterial infections in febrile children. Pediatr Res 83, 466–476 (2018). https://doi.org/10.1038/pr.2017.216
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DOI: https://doi.org/10.1038/pr.2017.216
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