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The Yale Observation Scale Score and the Risk of Serious Bacterial Infections in Febrile Infants. Pediatrics 2017 Jul;140(1)

Date

08/02/2017

Pubmed ID

28759413

Pubmed Central ID

PMC5495524

DOI

10.1542/peds.2017-0695

Scopus ID

2-s2.0-85021778119 (requires institutional sign-in at Scopus site)   61 Citations

Abstract

OBJECTIVES: To assess the performance of the Yale Observation Scale (YOS) score and unstructured clinician suspicion to identify febrile infants ≤60 days of age with and without serious bacterial infections (SBIs).

METHODS: We performed a planned secondary analysis of a prospective cohort of non-critically ill, febrile, full-term infants ≤60 days of age presenting to 1 of 26 participating emergency departments in the Pediatric Emergency Care Applied Research Network. We defined SBIs as urinary tract infections, bacteremia, or bacterial meningitis, with the latter 2 considered invasive bacterial infections. Emergency department clinicians applied the YOS (range: 6-30; normal score: ≤10) and estimated the risk of SBI using unstructured clinician suspicion (<1%, 1%-5%, 6%-10%, 11%-50%, or >50%).

RESULTS: Of the 4591 eligible infants, 444 (9.7%) had SBIs and 97 (2.1%) had invasive bacterial infections. Of the 4058 infants with YOS scores of ≤10, 388 (9.6%) had SBIs (sensitivity: 51/439 [11.6%]; 95% confidence interval [CI]: 8.8%-15.0%; negative predictive value: 3670/4058 [90.4%]; 95% CI: 89.5%-91.3%) and 72 (1.8%) had invasive bacterial infections (sensitivity 23/95 [24.2%], 95% CI: 16.0%-34.1%; negative predictive value: 3983/4055 [98.2%], 95% CI: 97.8%-98.6%). Of the infants with clinician suspicion of <1%, 106 had SBIs (6.4%) and 16 (1.0%) had invasive bacterial infections.

CONCLUSIONS: In this large prospective cohort of febrile infants ≤60 days of age, neither the YOS score nor unstructured clinician suspicion reliably identified those with invasive bacterial infections. More accurate clinical and laboratory predictors are needed to risk stratify febrile infants.

Author List

Nigrovic LE, Mahajan PV, Blumberg SM, Browne LR, Linakis JG, Ruddy RM, Bennett JE, Rogers AJ, Tzimenatos L, Powell EC, Alpern ER, Casper TC, Ramilo O, Kuppermann N, Febrile Infant Working Group of the Pediatric Emergency Care Applied Research Network (PECARN)

Author

Lorin Robert Browne DO Professor in the Pediatrics department at Medical College of Wisconsin




MESH terms used to index this publication - Major topics in bold

Bacterial Infections
Cross-Sectional Studies
Female
Fever
Humans
Infant
Infant, Newborn
Male
Prospective Studies
Risk Assessment
Severity of Illness Index