Emergency Medicine, NewYork-Presbyterian Hospital/Weill Cornell Medicine, New York, New York, USA
Emergency Medicine, Pediatric Emergency Medicine Associates (PEMA), Atlanta, Georgia, USA.
Emerg Med J. 2023 Mar;40(3):189-194. doi: 10.1136/emermed-2022-212575. Epub 2022 Nov 17.
Young infants with hypothermia presenting to the emergency department (ED) are at risk for serious bacterial infections (SBI), however there is no consensus temperature to prompt evaluation for SBI among these children. We sought to statistically derive a temperature threshold to guide detection of SBI in young infants with hypothermia presenting to the ED.
We performed a cross-sectional study of infants ≤90 days old presenting to four academic paediatric EDs in the United States of America from January 2015 through December 2019 with a rectal temperature of ≤36.4°C. Our primary outcomes were SBI, defined as urinary tract infection (UTI), bacteraemia and/or bacterial meningitis, and invasive bacterial infections (IBI, limited to bacteraemia and/or bacterial meningitis). We constructed receiver operating characteristic (ROC) curves to evaluate an optimally derived cutpoint for minimum ED temperature and presence of SBI or IBI.
We included 3376 infants, of whom SBI were found in 62 (1.8%) and IBI in 16 (0.5%). The most common infection identified was UTI. Overall, cohort minimum median temperature was 36.2°C (IQR 36.0°C-36.4°C). Patients with SBI and IBI had lower median temperatures, 35.8°C (IQR 35.8°C-36.3°C) and 35.4°C (IQR 35.7°C-36.3°C), respectively, compared with those without corresponding infections (both p<0.05). Using an outcome of SBI, the area under the ROC curve (AUROC) was 61.0% (95% CI 54.1% to 67.9%). At a cutpoint of 36.2°C, sensitivity was 59.7% and specificity was 59.2%. When using an outcome of IBI, the AUROC was 65.9% (95% CI 51.1% to 80.6%). Using a cutpoint of 36.1°C in this model resulted in a sensitivity of 68.8% and specificity of 60.1%.
Young infants with SBI and IBI presented with lower temperatures than infants without infections. However, there was no temperature threshold to reliably identify SBI or IBI. Further research incorporating clinical and laboratory parameters, in addition to temperature, may help to improve risk stratification for these vulnerable patients.
在急诊科（ED）就诊的体温过低的婴幼儿存在严重细菌感染（SBI）的风险，但目前尚没有共识的温度来提示这些儿童进行 SBI 的评估。我们试图从统计学上得出一个温度阈值，以指导体温过低的婴幼儿在 ED 中检测 SBI。
我们对 2015 年 1 月至 2019 年 12 月期间在美国四家学术儿科 ED 就诊的 ≤90 天大的婴儿进行了一项横断面研究，这些婴儿的直肠温度 ≤36.4°C。我们的主要结局是 SBI，定义为尿路感染（UTI）、菌血症和/或细菌性脑膜炎和侵袭性细菌感染（IBI，仅限于菌血症和/或细菌性脑膜炎）。我们构建了受试者工作特征（ROC）曲线，以评估最佳衍生的 ED 温度最低切点和 SBI 或 IBI 的存在。
我们纳入了 3376 名婴儿，其中 62 名（1.8%）发现 SBI，16 名（0.5%）发现 IBI。最常见的感染是 UTI。总体而言，队列的最低中位数温度为 36.2°C（IQR 36.0°C-36.4°C）。SBI 和 IBI 患者的中位数温度较低，分别为 35.8°C（IQR 35.8°C-36.3°C）和 35.4°C（IQR 35.7°C-36.3°C），与未感染相应感染的患者相比（均 p<0.05）。使用 SBI 作为结局，ROC 曲线下面积（AUROC）为 61.0%（95%CI 54.1%-67.9%）。在 36.2°C 的切点时，敏感性为 59.7%，特异性为 59.2%。当使用 IBI 作为结局时，AUROC 为 65.9%（95%CI 51.1%-80.6%）。在该模型中使用 36.1°C 的切点，敏感性为 68.8%，特异性为 60.1%。
患有 SBI 和 IBI 的婴幼儿的体温低于未感染的婴幼儿。然而，没有一个温度阈值可以可靠地识别 SBI 或 IBI。进一步研究纳入临床和实验室参数，除了温度，可能有助于改善这些脆弱患者的风险分层。
