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Prediction Rule to Identify Febrile Infants 61-90 Days at Low Risk for Invasive Bacterial Infections.

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Title: Prediction Rule to Identify Febrile Infants 61-90 Days at Low Risk for Invasive Bacterial Infections.
Authors: Aronson, Paul L., Mahajan, Prashant, Meeks, Huong D., Nielsen, Blake, Olsen, Cody S., Casper, T. Charles, Grundmeier, Robert W., Kuppermann, Nathan
Source: Pediatrics. Sep2025, Vol. 156 Issue 3, p1-11. 11p.
Subjects: Bacterial disease risk factors, Blood, Bacterial meningitis, Predictive tests, Pearson correlation (Statistics), Research funding, Fever in children, Bacteremia, Neutrophils, Probability theory, Calcitonin, Retrospective studies, Mann Whitney U Test, Cell culture, Body temperature, Longitudinal method, Urinalysis, Research, Medical records, Acquisition of data, Confidence intervals, Data analysis software, Clinical prediction rules, Cultures (Biology), Sensitivity & specificity (Statistics), Algorithms, Regression analysis, Disease risk factors
Abstract: OBJECTIVE: 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). METHODS: 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. RESULTS: 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). CONCLUSIONS: 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. [ABSTRACT FROM AUTHOR]
Copyright of Pediatrics is the property of American Academy of Pediatrics and its content may not be copied or emailed to multiple sites without the copyright holder's express written permission. Additionally, content may not be used with any artificial intelligence tools or machine learning technologies. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)
Database: Psychology and Behavioral Sciences Collection
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  Data: Prediction Rule to Identify Febrile Infants 61-90 Days at Low Risk for Invasive Bacterial Infections.
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– Name: Abstract
  Label: Abstract
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  Data: OBJECTIVE: 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). METHODS: 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. RESULTS: 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). CONCLUSIONS: 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. [ABSTRACT FROM AUTHOR]
– Name: AbstractSuppliedCopyright
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  Data: <i>Copyright of Pediatrics is the property of American Academy of Pediatrics and its content may not be copied or emailed to multiple sites without the copyright holder's express written permission. Additionally, content may not be used with any artificial intelligence tools or machine learning technologies. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract.</i> (Copyright applies to all Abstracts.)
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RecordInfo BibRecord:
  BibEntity:
    Identifiers:
      – Type: doi
        Value: 10.1542/peds.2025-071666
    Languages:
      – Code: eng
        Text: English
    PhysicalDescription:
      Pagination:
        PageCount: 11
        StartPage: 1
    Subjects:
      – SubjectFull: Bacterial disease risk factors
        Type: general
      – SubjectFull: Blood
        Type: general
      – SubjectFull: Bacterial meningitis
        Type: general
      – SubjectFull: Predictive tests
        Type: general
      – SubjectFull: Pearson correlation (Statistics)
        Type: general
      – SubjectFull: Research funding
        Type: general
      – SubjectFull: Fever in children
        Type: general
      – SubjectFull: Bacteremia
        Type: general
      – SubjectFull: Neutrophils
        Type: general
      – SubjectFull: Probability theory
        Type: general
      – SubjectFull: Calcitonin
        Type: general
      – SubjectFull: Retrospective studies
        Type: general
      – SubjectFull: Mann Whitney U Test
        Type: general
      – SubjectFull: Cell culture
        Type: general
      – SubjectFull: Body temperature
        Type: general
      – SubjectFull: Longitudinal method
        Type: general
      – SubjectFull: Urinalysis
        Type: general
      – SubjectFull: Research
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      – SubjectFull: Medical records
        Type: general
      – SubjectFull: Acquisition of data
        Type: general
      – SubjectFull: Confidence intervals
        Type: general
      – SubjectFull: Data analysis software
        Type: general
      – SubjectFull: Clinical prediction rules
        Type: general
      – SubjectFull: Cultures (Biology)
        Type: general
      – SubjectFull: Sensitivity & specificity (Statistics)
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      – SubjectFull: Algorithms
        Type: general
      – SubjectFull: Regression analysis
        Type: general
      – SubjectFull: Disease risk factors
        Type: general
    Titles:
      – TitleFull: Prediction Rule to Identify Febrile Infants 61-90 Days at Low Risk for Invasive Bacterial Infections.
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              M: 09
              Text: Sep2025
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