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Best Prediction Tools for SBI in Febrile Infants

December 30, 2019

Written by Rick Ramirez

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The NICE Traffic Light System outperformed the Severity Index Score (SIS) among well appearing febrile infants ≤3 months old for predicting serious illness. Rochester Criteria (RC) had the highest sensitivity of all the tools in infants 0-28 days.

Why does this matter?
Using predictive tools determining the risk of serious illness in febrile infants can be lifesaving. The NICE guideline and SIS are used in the pediatric population, but there is a paucity of literature comparing the effectiveness of these tools. With well-looking infants, the AAP found that the RC, Philadelphia Criteria (PC) and Boston Criteria (BC) are the most common strategies for managing the well-looking febrile infants without focal infection. The RC and PC have high NPV, which enables clinicians to confidently identify low-risk infants for serious infection.

Made a list and checked it twice? Naughty? Nah, let’s be NICE!
Serious illness included bacterial and viral illness such as meningitis and encephalitis. Febrile infants ≤3 months old were assigned to high/low-risk groups according to each of the five tools. The performance of the NICE guideline and SIS at initial clinical assessment for all infants and the low-risk criteria (RC, PC and BC) among well-looking infants were compared. Of 1,057 infants retrospectively analyzed, the NICE guideline had an overall sensitivity of 93.3% [95% CI 90.0 to 95.7], while SIS sensitivity was 79.1% [95% CI 74.3 to 83.4]. Among low risk criteria, RC performed with the highest sensitivity in infants aged 0–28 days [98.2%, 95% CI 90.3% to 100.0%] and 29–60 days [92.4%, 95% CI 86.0% to 96.5%], while the PC performed best in infants aged 61–90 days [100.0%, 95% CI 95.4% to 100.0%]. Overall, the NICE guideline and the RC had the highest sensitivities in predicting serious illness in febrile infants.

Analysis of emergency department prediction tools in evaluating febrile young infants at risk for serious infections. Emerg Med J. 2019 Dec;36(12):729-735. doi: 10.1136/emermed-2018-208210. Epub 2019 Oct 25.

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