背景:发热是急诊科儿科入院的常见原因。在3个月以下的人群中,很难获得病因诊断,因为它们往往具有较高的严重细菌感染率(SBI)。这项研究的目的是找到3个月以下不明原因发烧的儿童的SBI预测指标。
方法:对所有住院的3个月以下发热儿童进行研究,根据临床方案进行其他测试。还分析了确定SBI低风险发热婴儿的罗切斯特标准。设计了SBI和阳性文化的预测模型,在最大值模型中包括以下变量:C反应蛋白(CRP),降钙素原(PCT),并符合不少于四个罗切斯特标准。
结果:共纳入702名受试者,其中22.64%有SBI,20.65%有阳性培养。有SBI和阳性培养的儿童显示出更高的白细胞值,中性粒细胞总数,CRP和PCT。在少于4个罗切斯特标准下观察到统计学意义。CRP和PCT水平,SBI(曲线下面积[AUC]0.877),或阳性培养物(AUC0.888)。使用回归分析,计算了SBI或阳性培养的预测指数,灵敏度为87.7%和91%,特异性为70.1%和87.7%,LR+分别为2.93和3.62,LR-分别为0.17和0.10。
结论:预测模型是有效的,并略微提高了罗切斯特标准对发热住院不到3个月儿童的阳性培养的有效性。
BACKGROUND: Fever is a common cause of paediatric admissions in emergency departments. An aetiological diagnosis is difficult to obtain in those less than 3 months of age, as they tend to have a higher rate of serious bacterial infection (SBI). The aim of this study is to find a predictor index of SBI in children under 3 months old with fever of unknown origin.
METHODS: A study was conducted on all children under 3 months of age with fever admitted to hospital, with additional tests being performed according to the clinical protocol. Rochester criteria for identifying febrile infants at low risk for SBI were also analysed. A predictive model for SBI and positive cultures was designed, including the following variables in the maximum model: C-reactive protein (CRP), procalcitonin (PCT), and meeting not less than four of the Rochester criteria.
RESULTS: A total of 702 subjects were included, of which 22.64% had an SBI and 20.65% had positive cultures. Children who had SBI and a positive culture showed higher values of white cells, total neutrophils, CRP and PCT. A statistical significance was observed with less than 4 Rochester criteria, CRP and PCT levels, an SBI (area under the curve [AUC] 0.877), or for positive cultures (AUC 0.888). Using regression analysis a predictive index was calculated for SBI or a positive culture, with a sensitivity of 87.7 and 91%, a specificity of 70.1 and 87.7%, an LR+ of 2.93 and 3.62, and a LR- of 0.17 and 0.10, respectively.
CONCLUSIONS: The predictive models are valid and slightly improve the validity of the Rochester criteria for positive culture in children less than 3 months admitted with fever.