≤90天大的发热婴儿在急诊科(ED)寻求护理的患者中占很大比例。这些婴儿容易受到严重的细菌感染(SBI),需要早期识别才能及时进行调查和干预。我们的目的是研究婴儿在ED上的身高温度是否与SBI相关。
我们对2015年3月31日至2016年2月28日期间出现ED的≤90天大的发热婴儿进行了回顾性图表回顾。我们比较了有和没有SBI的发热婴儿的分诊温度。我们提出了敏感性,特异性,分诊时发热阈值的阳性和阴性预测值(PPV和NPV)。进行多变量回归以研究温度高度与SBI的存在之间的关系,并以相应的95%置信区间(CI)呈现调整比值比(aOR)。
在分析的1057名发热婴儿中,207人(19.6%)有SBI。患有SBI的婴儿的平均温度明显高于没有SBI的婴儿(平均38.5°C,标准偏差,SD0.6vs.38.3°C,SD0.5,p<0.005)。温度≥39°C时,灵敏度,特异性,SBI的PPV和NPV为15.5%(95CI10.8-21.1%),90.4%(95CI88.2-92.3%),分别为28.1%(95CI21.1-36.3%)和81.4%(95CI80.5-82.4%)。在调整年龄后,发烧的高度始终与SBI相关,性别和SIS(aOR1.76,95%CI1.32-2.33,p<0.001)。然而,32名(15.5%)SBI婴儿的初始分诊温度≤38℃。
在≤90日龄的发热婴儿中,分诊时温度较高与发生SBI的风险较高相关。然而,温度高度必须与其他危险因素结合使用,以识别年轻婴儿的SBI。
Febrile infants ≤ 90 days old make up a significant proportion of patients seeking care in the emergency department (ED). These infants are vulnerable to serious bacterial infections (SBIs) and early identification is required to initiate timely investigations and interventions. We aimed to study if height of an infant\'s temperature on presentation to the ED is associated with SBI.
We performed a retrospective chart review on febrile infants ≤ 90 days old presenting to our ED between 31st March 2015 and 28th February 2016. We compared triage temperature of febrile infants with and without SBIs. We presented sensitivity, specificity, positive and negative predictive values (PPV and NPV) of fever thresholds at triage. A multivariable regression was performed to study the association between height of temperature and the presence of SBI, and presented the adjusted odds ratio (aOR) with corresponding 95% confidence intervals (CI).
Among 1057 febrile infants analysed, 207 (19.6%) had a SBI. Mean temperature of infants with a SBI was significantly higher than those without (mean 38.5 °C, standard deviation, SD 0.6 vs. 38.3 °C, SD 0.5, p < 0.005). For temperature ≥ 39 °C, sensitivity, specificity, PPV and NPV for SBI was 15.5% (95%CI 10.8-21.1%), 90.4% (95%CI 88.2-92.3%), 28.1% (95%CI 21.1-36.3%) and 81.4% (95%CI 80.5-82.4%) respectively. The height of fever was consistently associated with SBI after adjusting for age, gender and SIS (aOR 1.76, 95% CI 1.32-2.33, p < 0.001). However, 32 (15.5%) infants with SBIs had an initial triage temperature ≤ 38 °C.
A higher temperature at triage was associated with a higher risk of SBI among febrile infants ≤ 90 days old. However, height of temperature must be used in conjunction with other risk factors to identify SBIs in young infants.