Aronson Paul L, Mahajan Prashant, Meeks Huong D, Nielsen Blake, Olsen Cody S, Casper T Charles, Grundmeier Robert W, Kuppermann Nathan
Section of Pediatric Emergency Medicine, Departments of Pediatrics and of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut.
Departments of Emergency Medicine and Pediatrics, University of Michigan, Ann Arbor, Missouri.
Pediatrics. 2025 Sep 1;156(3). doi: 10.1542/peds.2025-071666.
To derive and internally validate a clinical prediction rule to identify febrile infants aged 61-90 days at low risk of invasive bacterial infections (IBIs).
Using data from 17 Pediatric Emergency Care Applied Research Network Registry (PECARN) emergency departments, we included noncritically ill, previously healthy infants aged 61-90 days with temperatures greater than or equal to 38°C and urinalyses and blood cultures obtained between January 1, 2012, and April 30, 2024. Our outcome was IBI, defined as growth of pathogenic bacteria from blood or cerebrospinal fluid culture. Using recursive partitioning with 10-fold cross-validation, we derived and internally validated a prediction rule using age, temperature, urinalysis (negative/positive), and absolute neutrophil count (ANC) as candidate predictors. Limiting the analysis to infants with procalcitonin (PCT) and ANC results, we evaluated PCT as an additional predictor.
Of 4952 infants included, 100 (2.0%) had IBIs, including 95 (1.9%) with bacteremia without meningitis and 5 (0.1%) with bacterial meningitis. The optimal prediction rule identified low-risk infants as those with negative urinalyses and highest temperatures less than or equal to 38.9°C, yielding a sensitivity of 86.0% (95% CI, 77.6-92.1) and specificity of 58.9% (95% CI, 57.5-60.3). In the subset of 1207 infants with PCT and ANC measurements, including 27 (2.2%) with IBIs (2 [0.2%] with bacterial meningitis), we identified PCT of 0.24 ng/mL or less and ANC of 10 710 cells/mm3 or less as low-risk predictors. This PCT-based rule demonstrated sensitivity of 100.0% (95% CI, 87.2-100.0) and specificity of 65.8% (95% CI, 63.0-68.5).
We derived 2 accurate clinical prediction rules to identify febrile infants aged 61-90 days at low risk of IBIs when urine and blood testing are obtained. Prospective validation is needed.
推导并进行内部验证一种临床预测规则，以识别61至90日龄发热婴儿发生侵袭性细菌感染（IBIs）的低风险情况。
利用来自17个儿科急诊护理应用研究网络登记处（PECARN）急诊科的数据，我们纳入了非危重症、既往健康的61至90日龄婴儿，这些婴儿体温大于或等于38°C，并进行了2012年1月1日至2024年4月30日期间的尿液分析和血培养。我们的结局是IBI，定义为血液或脑脊液培养中病原菌生长。使用带有10倍交叉验证的递归划分方法，我们以年龄、体温、尿液分析（阴性/阳性）和绝对中性粒细胞计数（ANC）作为候选预测指标，推导并进行了内部验证一种预测规则。将分析限制在有降钙素原（PCT）和ANC结果的婴儿中，我们评估了PCT作为额外的预测指标。
在纳入的4952名婴儿中，100名（2.0%）发生了IBIs，包括95名（1.9%）无脑膜炎的菌血症患儿和5名（0.1%）细菌性脑膜炎患儿。最佳预测规则将低风险婴儿识别为尿液分析阴性且最高体温小于或等于38.9°C的婴儿，灵敏度为86.0%（95%CI，77.6 - 92.1），特异度为58.9%（95%CI，57.5 - 60.3）。在1207名有PCT和ANC测量值的婴儿亚组中，包括27名（2.2%）发生IBIs的患儿（2名[0.2%]细菌性脑膜炎患儿），我们将PCT为0.24 ng/mL或更低且ANC为10710个细胞/mm3或更低识别为低风险预测指标。这个基于PCT的规则显示灵敏度为100.0%（95%CI，87.2 - 100.0），特异度为65.8%（95%CI，63.0 - 68.5）。
我们推导了2种准确的临床预测规则，以在进行尿液和血液检测时识别61至90日龄发热婴儿发生IBIs的低风险情况。需要进行前瞻性验证。
