Yilmaz Hayri Levent, Yildizdas Riza Dincer, Alparslan Nazan, Ozcan Kenan, Yaman Akgun, Kibar Filiz
Medical Faculty of Cukurova University, Department of Paediatric Emergency Medicine, Adana, Turkey.
Ann Acad Med Singap. 2008 Mar;37(3):192-9.
This is a prospective, observational study. The aims of the study were to determine the rate of bacteraemia in febrile children in Turkey, and to evaluate the usefulness of white blood cell (WBC) count and manual differential counts of peripheral blood smears and a RISK score in predicting bacteraemia among these children.
A total of 377 febrile children aged 3 to 36 months were included in the study. Complete blood cell (CBC) count, manual differential counts and blood cultures were performed in all patients. The main outcome measures used to evaluate the usefulness of the RISK score were sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), odds ratio (OR), posterior probability, areas under receiver operator characteristic curves (AUC) and miss-to-diagnosis ratio (MDR).
Among the patients, 4.4% had bacteraemia and the predominant pathogen was Streptococcus pneumoniae. The Yale Observation Scale scores, percentages of neutrophil and bands, band-neutrophil ratio, absolute neutrophil count and absolute band count were found to be statistically significant predictors of bacteraemia. When the RISK score was 2 or higher, sensitivity was 93.8%, false positive ratio 35.8%, PPV 10.6%, NPV 99.5%, OR 26.2 (95% CI, 3.4 to 200.8), MDR 0.066 and posterior probability value 10%.
We conclude that determination of the RISK score will significantly decrease unnecessary blood culture sampling, antibiotherapy and hospitalisation among febrile patients aged 3 to 36 months without an identifiable focus of infection.
这是一项前瞻性观察性研究。该研究的目的是确定土耳其发热儿童的菌血症发生率，并评估白细胞（WBC）计数、外周血涂片手工分类计数以及风险评分在预测这些儿童菌血症方面的有用性。
本研究共纳入377名3至36个月大的发热儿童。所有患者均进行了全血细胞计数（CBC）、手工分类计数和血培养。用于评估风险评分有用性的主要结局指标包括敏感性、特异性、阳性预测值（PPV）、阴性预测值（NPV）、比值比（OR）、后验概率、受试者操作特征曲线下面积（AUC）和漏诊与诊断比（MDR）。
患者中4.4%发生菌血症，主要病原体为肺炎链球菌。耶鲁观察量表评分、中性粒细胞和杆状核细胞百分比、杆状核细胞与中性粒细胞比值、绝对中性粒细胞计数和绝对杆状核细胞计数被发现是菌血症的统计学显著预测指标。当风险评分为2或更高时，敏感性为93.8%，假阳性率为35.8%，PPV为10.6%，NPV为99.5%，OR为26.2（95%CI，3.4至200.8），MDR为0.066，后验概率值为10%。
我们得出结论，对于3至36个月大且无明确感染灶的发热患者，确定风险评分将显著减少不必要的血培养采样、抗生素治疗和住院治疗。
