Department of Pediatrics, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands.
Department of Public Health, Centre of Medical Decision Making, Erasmus MC-University Medical Center Rotterdam, Rotterdam, The Netherlands.
Pediatr Res. 2018 Feb;83(2):466-476. doi: 10.1038/pr.2017.216. Epub 2017 Nov 8.
BackgroundTo 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.MethodsThis 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.ResultsA 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.ConclusionThis 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.
为了验证 Feverkidstool，一种由临床症状和 C 反应蛋白（CRP）组成的预测模型，用于识别发热儿童中的严重细菌感染（SBI），并确定降钙素原的额外诊断价值。
这是一项在荷兰两家急诊部门进行的前瞻性观察性研究，纳入了发热的儿童，年龄在 1 个月至 16 岁之间。使用标准化的、常规收集的临床症状和体征、CRP 和降钙素原数据，通过多项逻辑回归，开发出区分“肺炎”和“其他 SBI”与“非 SBI”的预测模型。
共纳入 1085 名儿童，中位数年龄为 1.6 岁（四分位距 0.8-3.4）；73 名儿童（7%）患有肺炎，98 名儿童（9%）患有其他 SBI。Feverkidstool 在这个新人群中表现出良好的判别能力。在 Feverkidstool 中添加降钙素原后，“肺炎”的 c 统计量从 0.85（95%置信区间 0.76-0.94）增加到 0.86（0.77-0.94），“其他 SBI”从 0.81（0.73-0.90）增加到 0.83（0.75-0.91）。具有临床特征和降钙素原的模型与 Feverkidstool 表现相似。
本研究证实了 Feverkidstool 的外部有效性，CRP 和降钙素原在预测我们发热儿童人群中的 SBI 方面具有同等价值。我们的研究结果不支持 CRP 和降钙素原的常规双重使用。
