Nijman et al reported clinical findings associated with serious bacterial infections (SBI) in febrile children. These can help to identify a child who may require more aggressive management. The authors are from Erasmus Medical Center and Sophia's Children's Hospital, Oxford University and Haga-Juliana Children’s Hospital at the Hague.
Patient selection: febrile child or adolescent from 1 month to 15 years
Predictors of pneumonia:
(1) tachypnea
(2) oxygen saturation < 94%
(3) elevated serum CRP
Predictors of other SBIs (sepsis, meningitis, UTIs):
(1) elevated serum CRP
Exclusion of other SBIs (favor pneumonia):
(1) chest wall retactions
(2) oxygen saturation < 94%
Parameter
Finding
Points for Pneumonia
age in years
<= 1 year
(1.02 * (age)) + (0.01 * (age))
> 1 year
(0.01 * ((age) - 1) + 1.02
sex
female
0.13
male
0
temperature °C
0.29 * (temperature)
fever duration in days
0.21 * (days)
tachypnea
no
0
yes
0.44
tachycardia
no
0
yes
-0.04
oxygen saturation
>= 94%
0
< 94%
1.59
capillary refill
<= 3 seconds
0
> 3 seconds
-0.18
chest wall retractions
no
0
yes
0.47
ill-appearing
no
0
yes
0.16
serum CRP in mg/L
0.64 * LN(CRP)
value of X for pneumonia =
= SUM(points) - 17.9
Parameter
Finding
Points for Pneumonia
age in years
<= 1 year
(-1.73 * (age)) + (0.11 * (age))
> 1 year
(0.11 * ((age) - 1) - 1.73
sex
female
0.7
male
0
temperature °C
-0.02 * (temperature)
fever duration in days
-0.03 * (days)
tachypnea
no
0
yes
-0.11
tachycardia
no
0
yes
-0.02
oxygen saturation
>= 94%
0
< 94%
-3.29
capillary refill
<= 3 seconds
0
> 3 seconds
0.3
chest wall retractions
no
0
yes
-3.78
ill-appearing
no
0
yes
0.27
serum CRP in mg/L
1.14 * LN(CRP)
value of Y for other SBI =
= SUM(points) - 4.7
risk of pneumonia =
= EXP(X) / (1 + EXP(X) + EXP(Y))
risk of other SBI =
= EXP(Y) / (1 + EXP(X) + EXP(Y)))
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