Diagnostic value of clinical features at presentation to identify serious infection in children in developed countries: a systematic review
The LancetPublished 3 February 2010
Ann Van den Bruel, T Haj-Hassan, Matthew Thompson, Frank Buntinx, David Mant
Citations319
SJR quartileQ1
SJR score12.11
SNIP22.72
Generate an AI Snapshot to get a quick, structured summary of this paper.
Study Snapshot
ObjectiveStudy objective
MethodsResearch methodology
PopulationPopulation studied
Sample sizeSample sizes
OutcomesStudy outcomes here
ResultsStudy results comes here
LimitationsResearch study limitations comes here
A concise AI-generated summary of the paper will appear here once you click Generate AI Snapshot.
TL;DR
No single clinical feature has rule-out value but some combinations can be used to exclude the possibility of serious infection-for example, pneumonia is very unlikely (negative likelihood ratio 0.01-0.46) if the child is not short of breath and there is no parental concern.
Abstract
Health Technology Assessment and National Institute for Health Research National School for Primary Care Research.
Keywords
Immunology and MicrobiologyMedicine
BMC Medical Research MethodologyThe development of QUADAS: a tool for the quality assessment of studies of diagnostic accuracy included in systematic reviews
3,624 Citations2003Penny Whiting, Anne WS Rutjes +3 more
JAMAUsers' guides to the medical literature
2,981 Citations1993Gordon Guyatt
A 55-year-old man who had his serum cholesterol level measured at a shopping mall 2 months ago has an elevated cholesterol level, but before deciding on a treatment recommendation, you elect to find out just how big a reduction in the risk of CHD this patient could expect from a cholesterollowering diet or drug therapy.
JAMAUsers' Guides to the Medical Literature
2,178 Citations1994Roman Jaeschke
The patient is a 28-year-old man whose acute onset of shortness of breath and vague chest pain began shortly after completing a 10-hour auto trip, and the physician is very apprehensive about his symptoms.
JAMAUsers' guides to the medical literature. III. How to use an article about a diagnostic test. B. What are the results and will they help me in caring for my patients? The Evidence-Based Medicine Working Group
1,830 Citations1994Roman Jaeschke
You are back where you were in the previous article1 on diagnostic tests: in the library studying an article that will guide you in interpreting ventilation-perfusion (V/Q) lung scans.
The LancetClinical recognition of meningococcal disease in children and adolescents
558 Citations2006Matthew Thompson, Nelly Ninis +7 more
The framework within which meningococcal disease is diagnosed should be changed to emphasise identification of these early symptoms by parents and clinicians to shorten the time to hospital admission.
PubMedIntegrated management of childhood illness by outpatient health workers: technical basis and overview. The WHO Working Group on Guidelines for Integrated Management of the Sick Child.
486 Citations1997S Gove
The technical basis for the guidelines for the integrated management of childhood illness (IMCI) are described, which are presented in the WHO/UNICEF training course on IMCI for outpatient health workers at first-level health facilities in developing countries.
New England Journal of MedicineOutpatient Management without Antibiotics of Fever in Selected Infants
478 Citations1993M. Douglas Baker, Louis M. Bell +1 more
With the use of strict screening criteria, a substantial number of febrile one-to-two-month-old infants can be cared for safely as outpatients and without antibiotics.
The Journal of UrologyHow to Use an Article About a Diagnostic Test
457 Citations2008Charles D. Scales, Philipp Dahm +3 more
The LancetClinical signs that predict severe illness in children under age 2 months: a multicentre study
409 Citations2008
A single simple algorithm could be recommended for identifying severe illness in infants aged 0-2 months who are brought to health facilities and did well in 7-59-day-old infants, excluding jaundice.
PEDIATRICSObservation Scales to Identify Serious Illness in Febrile Children
362 Citations1982Paul L. McCarthy, Michael R. Sharpe +7 more
In the population studied, this predictive model, when used prior to history and physical examination, was reliable, predictive, specific, and sensitive for serious illness in febrile children.
PEDIATRICSValidity and Reliability of Clinical Signs in the Diagnosis of Dehydration in Children
335 Citations1997Marc H. Gorelick, Kathy N. Shaw +1 more
Conventionally used clinical signs of dehydration are valid and reliable; however, individual findings lack sensitivity and should be based on the presence of at least three clinical findings.
BMJWhat worries parents when their preschool children are acutely ill, and why: a qualitative study
282 Citations1996Joe Kai
Modification of parents' personal control and perceived threat using appropriate information and education that acknowledge and address their concerns may be a means of empowering parents.
PEDIATRICSPredictive Model for Serious Bacterial Infections Among Infants Younger Than 3 Months of Age
269 Citations2001Richard G. Bachur, Marvin B. Harper
Decision-tree analysis using common clinical variables can reasonably predict febrile infants at high-risk for SBI, and can identify infants who are at high risk of SBI with a relative risk of 12.1 compared with lower-risk infants.
The Pediatric Infectious Disease JournalProcalcitonin and C-Reactive Protein as Diagnostic Markers of Severe Bacterial Infections in Febrile Infants and Children in the Emergency Department
265 Citations2007Barbara Andreola, Silvia Bressan +4 more
Both PCT and CRP are valuable markers in predicting SBI in children with fever without source and they perform better than WBC and ANC, which appears more accurate at the beginning of infections.
The Journal of PediatricsBacteremia in febrile children under 2 years of age: Results of cultures of blood of 600 consecutive febrile children seen in a “walk-in” clinic
262 Citations1975David W. Teele, Stephen I. Pelton +6 more
Bacteremia was most frequent in children 7 to 24 months of age and was commonly associated with an elevated white blood cell count and fever.
PEDIATRICSBedside Procalcitonin and C-Reactive Protein Tests in Children With Fever Without Localizing Signs of Infection Seen in a Referral Center
222 Citations2003Annick Galetto-Lacour, Samuel A. Zamora +1 more
PCT and CRP performed better than IL-6, WBC, and/or band count in predicting the occurrence of SBI and should be considered in the initial work-up of children with fever without source.
European Journal of PediatricsProcalcitonin, IL-6, IL-8, IL-1 receptor antagonist and C-reactive protein as identificators of serious bacterial infections in children with fever without localising signs
188 Citations2001Annick Galetto Lacour, Alain Gervaix +5 more
Compared to commonly used screening methods such as the McCarthy score, leucocyte count and other inflammatory markers, procalcitonin and C-reactive protein offer a better sensitivity and specificity in predicting serious bacterial infection in children with fever without localising signs.
PEDIATRICSFailure of Infant Observation Scales in Detecting Serious Illness in Febrile, 4-to 8-Week-Old Infants
187 Citations1990M. Douglas Baker, Jeffrey R. Avner +1 more
The findings suggest that even in experienced hands, the Yale Observation Scale alone does not provide sufficient data to identify serious illness in febrile, 1- to 2-month-old infants.
The LancetCLINICAL SIGNS OF DEHYDRATION IN CHILDREN
182 Citations1989Angela Mackenzie, Graeme Barnes +1 more
PubMedSigns and symptoms for diagnosis of serious infections in children: a prospective study in primary care.
180 Citations2007Ann Van den Bruel, Bert Aertgeerts +3 more
Some individual signs have high specificity and a serious infection can be excluded based on a limited number of signs and symptoms, and a multivariable triage instrument is created.
British Journal of General PracticeDiagnostic safety-netting
160 Citations2009Susanna C Almond, David Mant +1 more
Safety-netting is critically important if the diagnosis is known but carries a significant risk of serious complications either in itself or because the individual characteristics of the patient put them at particularly high risk of …
Archives of Disease in ChildhoodAudit: Determining the common medical presenting problems to an accident and emergency department
143 Citations2001Kate Armon
Guidelines developed for A&E should target the commonest presenting problem categories, six of which account for 83% of all medical attendances, and be directed towards senior house officers.
PEDIATRICSThe Efficacy of Routine Outpatient Management Without Antibiotics of Fever in Selected Infants
141 Citations1999M. Douglas Baker, Louis M. Bell +1 more
The Philadelphia protocol for outpatient management without antibiotics of FIs at low risk for SBI remains practical, reliable, and safe.
PEDIATRICSIncidence and Predictors of Serious Bacterial Infections Among 57- to 180-Day-Old Infants
117 Citations2006Allen Hsiao, Lei Chen +1 more
A substantial proportion of older febrile infants has SBI, and Infants older than 8 weeks remain at risk for bacteremia and bacteruria, regardless of positive DFA or other apparent source of fever.
PEDIATRICSTemperature and Total White Blood Cell Count as Indicators of Bacteremia
107 Citations1991David M. Jaffe, Gary Fleisher
This study was designed to quantify more precisely the accuracy of magnitude of rectal temperature and total white blood cell count as indicators of bacteremia in children with an obvious focal bacterial infection.
Archives of Pediatrics and Adolescent MedicineEstablishing Clinically Relevant Standards for Tachypnea in Febrile Children Younger Than 2 Years
106 Citations1995James A. Taylor
Archives of Disease in ChildhoodHow well do vital signs identify children with serious infections in paediatric emergency care?
105 Citations2009Matthew Thompson, Jane Coad +4 more
PubMedEveryday symptoms in childhood: occurrence and general practitioner consultation rates.
101 Citations1998Marc Bruijnzeels, M. Foets +3 more
This study emphasizes the enormous amount of illness that occurs in children and the fact that more than 80% of all illnesses are dealt with by parents without reference to the professional health care system.
Clinical PediatricsIdentifying Children with Pneumonia in the Emergency Department
101 Citations2005E. Melinda Mahabee‐Gittens, Jacqueline Grupp‐Phelan +6 more
The combination of age older than 12 years, RR 50 or greater, oxygen saturation 96% or less, and in children under age 12 months, nasal flaring, can be used in determining which young children with lower respiratory tract infection symptoms have radiographic pneumonia.
The Pediatric Infectious Disease JournalA Score Identifying Serious Bacterial Infections in Children With Fever Without Source
96 Citations2008Annick Galetto Lacour, Samuel A. Zamora +1 more
Archives of Disease in ChildhoodThe child with a non-blanching rash: how likely is meningococcal disease?
91 Citations2001Louise Wells
Most children with meningococcal infection are ill, have a purpuric rash, a fever, and delayed capillary refill, and should be admitted to hospital and treated without delay.
PEDIATRICSProspective Evaluation of the Risk of Serious Bacterial Infection in Children Who Present to the Emergency Department With Hyperpyrexia (Temperature of 106°F or Higher)
84 Citations2006Barbara W. Trautner, A. Chantal Caviness +3 more
Children with hyperpyrexia are at equally high risk for serious bacterial infection and for viral illness, and no aspect of the clinical presentation reliably distinguishes between bacterial and viral illness.
Acta PaediatricaIs procalcitonin useful in early diagnosis of serious bacterial infections in children?
80 Citations2005Sudhin Thayyil, Mohan Shenoy +4 more
To compare diagnostic accuracy of procalcitonin for early diagnosis of serious bacterial infection (SBI) in children presenting with fever and no focus of infection, a prospective study involving 72 children presenting to the paediatric units of two university hospitals is conducted.
The Journal of PediatricsObservation, history, and physical examination in diagnosis of serious illnesses in febrile children ≤24 months
79 Citations1987Paul L. McCarthy, Robert M. Lembo +3 more
Assessment of appearance in a child with fever, when performed in a careful, integrated, stepwise fashion, improves the sensitivity of the history and physical examination in detecting serious illnesses in febrile children.
American journal of diseases of childrenWhich Children With Febrile Seizures Need Lumbar Puncture?
78 Citations1983Alain Joffe
Five history and physical examination items discriminated between children with and without meningitis: a physician visit within 48 hours before the seizure; the occurrence of convulsions on arrival at the emergency room; a focal seizure; suspicious findings on physical and/or neurologic examination; and negative predictive value was 100%.
PEDIATRICSA Novel Imaging Technique to Measure Capillary-Refill Time: Improving Diagnostic Accuracy for Dehydration in Young Children With Gastroenteritis
74 Citations2006Itai Shavit, Rollin Brant +3 more
Results of this prospective cohort study suggest that digitally measured capillary-refill time more accurately predicts significant dehydration (≥5%) in young children with gastroenteritis than overall clinical assessment.
Acta PaediatricaPrediction of bacterial meningitis in children with meningeal signs: reduction of lumbar punctures
71 Citations2001Rianne Oostenbrink, KGM Moons +3 more
The aim of this study was to derive and validate a clinical rule to predict bacterial meningitis in children with meningeal signs, to guide decisions on the performance of lumbar punctures.
BMJLesson of the Week: Who spots the spots? Diagnosis and treatment of early meningococcal disease in children
69 Citations1996F.A.I. Riordan, Alistair Thomson +2 more
Acta PaediatricaValidating and updating a prediction rule for serious bacterial infection in patients with fever without source
68 Citations2006SE Bleeker, G Derksen‐Lubsen +4 more
The aim is to externally validate and update a previously developed rule for predicting the presence of serious bacterial infections in children with fever without apparent source.
Archives of Disease in ChildhoodDiagnostic assessment of haemorrhagic rash and fever
67 Citations2001H. E. Nielsen, Erik Arthur Andersen +8 more
This diagnostic algorithm did not identify children in whom septicaemia was caused by other bacterial species, and the probability of identifying a patient with meningococcal disease was 97% and the false positive rate was only 12%.
Academic Emergency MedicineReappraisal of Criteria Used to Predict Serious Bacterial Illness in Febrile Infants Less than 8 Weeks of Age
67 Citations2005Gregory Garra
The Philadelphia protocol and the Rochester criteria maintained their previously reported NPVs when applied to a new population of febrile infants, illustrating the usefulness of retesting clinical decision rules in new populations prior to their universal acceptance.
European Journal of PediatricsA predictive model to estimate the risk of serious bacterial infections in febrile infants
61 Citations1996Rudolphus Berger, Marjolein Y. Berger +3 more
CRP, duration of fever, the “standardized clinical impression score”, a history of diarrhoea and focal signs of infection were the independent, most powerful predictors of SBI in febrile infants, identified by logistic regression analysis.
The Medical Journal of AustraliaBacteraemia in febrile children presenting to a paediatric emergency department
52 Citations1999Rachael A Haddon, Peter Barnett +2 more
To determine the prevalence of bacteraemia in young febrile children presenting to a paediatric emergency department, a large number of children diagnosed with fever, diarrhoea, or vomiting in the first six months of the year are surveyed.
Journal of InfectionThe Causes of Fever in Children Attending Hospital in the North of England
46 Citations2001Zohreh Nademi, Julia Clark +3 more
It is suggested that high fever and WBC count can not replace clinical assessment of the child with a temperature, and poor feeding and restlessness predicted serious disease with a sensitivity of 78% and 76%, respectively.
PubMedImpact of infections on primary care--greater than expected.
45 Citations2002Fleming Dm, Smith Ge +3 more
The burden of illness attributable to infection in primary care by analysing data from the fourth practice-based national morbidity survey is examined, emphasising the importance of adequate training for general practitioners in the natural history, epidemiology, diagnosis and treatment of infection.
Clinical PediatricsSeizures and Fever: Can We Rule Out Meningitis on Clinical Grounds Alone?
43 Citations1992Martin Offringa, Auke Beishuizen +2 more
It is indicated that based on available clinical data, meningitis can be ruled out in children presenting with seizures and fever; thus, there is no need for routine investigation of cerebrospinal fluid.
Clinical PediatricsEfficacy of a Protocol to Distinguish Risk of Serious Bacterial Infection in the Outpatient Evaluation of Febrile Young Infants
42 Citations1993William Bonadio, E.W. Hagen +4 more
Managing UP infants as outpatients avoided 48 to 72 hours of hospitalization, decreasing health-care costs by an estimated total of $465,170, and had a sensitivity and negative predictive value for distinguishing SBI outcome.
Annals of Emergency MedicineOccult bacteremia in the emergency department: Diagnostic criteria for the young febrile child
25 Citations1985Patrick Crocker, Gary Quick +1 more
It is concluded that an easily obtained data base may be useful in the prospective identification of those at risk for bacteremia and Identification of such a group is useful to the emergency physician because early antibiotic therapy may lessen morbidity and mortality.
Archives of Disease in ChildhoodField trials of the Baby Check score card in general practice.
22 Citations1991Colin J. Morley, Alison J. Thornton +2 more
The use of Baby Check by GPs would help them assess babies thoroughly and quantify illness severity objectively and help the mothers in their practice to use it.
Archives of Disease in ChildhoodThe management of sick young infants at primary health centres in a rural developing country
16 Citations2005Trevor Duke
Clinical signs with moderate positive predictive value for death may be useful triggers for emergency treatment and longer observation or urgent referral in developing countries.
Anales de PediatríaEl niño febril. Resultados de un estudio multicéntrico
13 Citations2001C. Luaces Cubells, C. Luaces Cubells
Objetivos Establecer el valor pronostico de los parametros clinicosy analiticos recogidos en un protocolo de estudio multicentricosobre el nino febril visitado enservicios de urgencias hospitalarios.
PubMedManagement of febrile children in a paediatric emergency department.
7 Citations2002Osama M. Osman, David F.M. Brown +2 more
Enhancement of the role of ambulatory paediatrics in the care of febrile children may be more cost-effective than anticipatory hospitalisation.