Department of Paediatrics, KK Women's and Children's Hospital Singapore, 100, Bukit Timah Road, Singapore, 229899, Singapore.
Department of Emergency Medicine, KK Women's and Children's Hospital, Singapore, Singapore.
BMC Pediatr. 2022 Apr 8;22(1):188. doi: 10.1186/s12887-022-03264-8.
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 31 March 2015 and 28 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.
发热婴儿（≤90 天）在急诊科就诊的患者中占很大比例。这些婴儿容易发生严重细菌感染（SBI），需要早期识别，以便及时进行调查和干预。我们旨在研究婴儿就诊时的体温高度是否与 SBI 相关。
我们对 2015 年 3 月 31 日至 2016 年 2 月 28 日期间在我院急诊科就诊的≤90 天发热婴儿进行了回顾性图表审查。我们比较了发热婴儿的分诊温度和有无 SBI 的婴儿。我们呈现了分诊时发热阈值的敏感性、特异性、阳性和阴性预测值（PPV 和 NPV）。采用多变量回归研究体温高度与 SBI 之间的关系，并呈现调整后的优势比（aOR）及其对应的 95%置信区间（CI）。
在分析的 1057 名发热婴儿中，207 名（19.6%）患有 SBI。患有 SBI 的婴儿的平均体温明显高于未患有 SBI 的婴儿（平均 38.5°C，标准差 0.6 与 38.3°C，标准差 0.5，p<0.005）。对于体温≥39°C，SBI 的敏感性、特异性、PPV 和 NPV 分别为 15.5%（95%CI 10.8-21.1%）、90.4%（95%CI 88.2-92.3%）、28.1%（95%CI 21.1-36.3%）和 81.4%（95%CI 80.5-82.4%）。在调整年龄、性别和 SIS 后，发热的高度始终与 SBI 相关（aOR 1.76，95%CI 1.32-2.33，p<0.001）。然而，32 名（15.5%）患有 SBI 的婴儿的初始分诊温度≤38°C。
在≤90 天的发热婴儿中，分诊时的体温升高与 SBI 的风险增加相关。然而，必须结合其他危险因素来识别小婴儿的 SBI。
