Departments of Pediatrics.
University of Rochester Medical Center, Department of Public Health Sciences, Rochester, New York.
Hosp Pediatr. 2023 Mar 1;13(3):e47-e50. doi: 10.1542/hpeds.2022-006820.
In the absence of procalcitonin, the American Academy of Pediatrics' clinical practice guideline (CPG) for evaluating and managing febrile infants recommends using previously untested combinations of inflammatory marker thresholds. Thus, CPG performance in detecting invasive bacterial infections (IBIs; bacteremia, bacterial meningitis) is poorly understood.
To evaluate CPG performance without procalcitonin in detecting IBIs in well-appearing febrile infants 8 to 60 days old.
For this cross-sectional, single-site study, we manually abstracted data for febrile infants using electronic health records from 2011 to 2018. We used CPG inclusion/exclusion criteria to identify eligible infants and stratified IBI risk with CPG inflammatory marker thresholds for temperature, absolute neutrophil count, and C-reactive protein. Because the CPG permits a wide array of interpretations, we performed 3 sensitivity analyses, modifying age and inflammatory marker thresholds. For each approach, we calculated area-under-the-receiver operating characteristic curve, sensitivity, and specificity in detecting IBIs.
For this study, 507 infants met the inclusion criteria. For the main analysis, we observed an area-under-the-receiver operating characteristic curve of 0.673 (95% confidence interval 0.652-0.694), sensitivity of 100% (66.4%-100%), and specificity of 34.5% (30.4%-38.9%). For the sensitivity analyses, sensitivities were all 100% and specificities ranged from 9% to 38%.
Findings suggest that the CPG is highly sensitive, minimizing missed IBIs, but specificity may be lower than previously reported. Future studies should prospectively investigate CPG performance in larger, multisite samples.
在美国儿科学会（AAP）评估和管理发热婴儿的临床实践指南（CPG）缺乏降钙素原的情况下，建议使用以前未经测试的炎症标志物阈值组合。因此，CPG 在检测侵袭性细菌性感染（IBI；菌血症、细菌性脑膜炎）方面的性能尚不清楚。
评估无降钙素原时 CPG 在检测 8 至 60 天龄外观良好的发热婴儿中的 IBI 的性能。
在这项横断面、单站点研究中，我们使用电子健康记录从 2011 年至 2018 年手动提取发热婴儿的数据。我们使用 CPG 的纳入/排除标准来识别合格的婴儿，并根据 CPG 炎症标志物阈值对体温、绝对中性粒细胞计数和 C 反应蛋白进行 IBI 风险分层。由于 CPG 允许广泛的解释，我们进行了 3 项敏感性分析，修改了年龄和炎症标志物阈值。对于每种方法，我们计算了检测 IBI 的受试者工作特征曲线下面积、敏感性和特异性。
这项研究共纳入了 507 名婴儿。在主要分析中，我们观察到受试者工作特征曲线下面积为 0.673（95%置信区间 0.652-0.694），敏感性为 100%（66.4%-100%），特异性为 34.5%（30.4%-38.9%）。在敏感性分析中，敏感性均为 100%，特异性范围为 9%至 38%。
这些发现表明，CPG 具有很高的敏感性，最大限度地减少了漏诊的 IBI，但特异性可能低于先前报道。未来的研究应前瞻性地在更大、多站点的样本中调查 CPG 的性能。
