Hameed Tahir K, Almadani Salma H, Shahin Walaa A, Ardah Husam I, Almaghrabi Walaa A, Alhabdan Mohammed A, Alfaidi Ahmed M, Abuthamerah Asma M, Alahmadi Manar M, Almalki Malik H, Aldabbagh Mona A
Department of Pediatrics, King Abdulaziz Medical City - Riyadh, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia.
King Saud bin Abdulaziz University for Health Sciences - Riyadh, Riyadh, Saudi Arabia.
BMC Pediatr. 2025 Nov 13;25(1):928. doi: 10.1186/s12887-025-06285-1.
Prediction rules using biomarkers to stratify young febrile infants at low risk for bacterial infections have been developed over the last decade in North America and Europe. The aim of this study was to validate the Pediatric Emergency Care Applied Research Network (PECARN) prediction rule for febrile infants 90 days of age and younger presenting to the emergency department (ED) in tertiary care centers in Saudi Arabia.
A multi-center retrospective study was conducted on febrile infants who presented to the ED at 3 Saudi hospitals between January 2018 and June 2021. Patients were included if they were full-term, 0-90 days of age, had documented fever, and procalcitonin (PCT) performed.
A total of 327 patients met inclusion criteria. Fifty-three patients (16.2%) had serious bacterial infections (SBIs), 33 with urinary tract infection (UTI) alone and 20 with invasive bacterial infections (IBIs) (bacteremia and/or bacterial meningitis). The mean absolute neutrophil count was 6.6 × 10/L in infants with SBIs as compared to 4.3 × 10/L in infants without SBIs (p = 0.0015). The mean PCT was 8.7 ng/mL in those with SBIs versus 0.5 ng/mL in those without SBIs (p < 0.0001). Nine patients who were classified as low-risk according to the PECARN rule had SBIs; 7 were infants with UTIs and 2 were infants under 3 weeks of age with IBIs. The sensitivity and negative predictive value of the PECARN prediction rule for SBIs was 80.4% and 92.1%, respectively.
SBIs are common in our population, and the PECARN prediction rule performed well in classifying febrile infants at low risk for SBIs. The prediction rule was very accurate in ruling out IBIs, with no misclassified cases in infants 3 weeks of age and older. Our study helps validate the applicability of the PECARN prediction rule in our setting.
在过去十年中，北美和欧洲已开发出利用生物标志物对细菌性感染低风险的发热婴幼儿进行分层的预测规则。本研究的目的是验证儿科急诊护理应用研究网络（PECARN）针对沙特阿拉伯三级护理中心急诊科90日龄及以下发热婴幼儿的预测规则。
对2018年1月至2021年6月期间在沙特3家医院急诊科就诊的发热婴幼儿进行了一项多中心回顾性研究。纳入的患者须为足月儿、0至90日龄、有发热记录且检测了降钙素原（PCT）。
共有327例患者符合纳入标准。53例患者（16.2%）发生了严重细菌感染（SBI），其中33例仅为尿路感染（UTI），20例为侵袭性细菌感染（IBI）（菌血症和/或细菌性脑膜炎）。发生SBI的婴幼儿平均绝对中性粒细胞计数为6.6×10⁹/L，而未发生SBI的婴幼儿为4.3×10⁹/L（p = 0.0015）。发生SBI的患者平均PCT为8.7 ng/mL，未发生SBI的患者为0.5 ng/mL（p < 0.0001）。根据PECARN规则被分类为低风险的9例患者发生了SBI；7例为UTI婴幼儿，2例为3周龄以下发生IBI的婴幼儿。PECARN预测规则对SBI的敏感性和阴性预测值分别为80.4%和92.1%。
SBI在我们的研究人群中很常见，PECARN预测规则在对SBI低风险的发热婴幼儿进行分类方面表现良好。该预测规则在排除IBI方面非常准确，3周龄及以上婴幼儿中无分类错误的病例。我们的研究有助于验证PECARN预测规则在我们的研究环境中的适用性。
