Clinical Prediction Rule of Kuppermann et al for Identifying a Febrile Infant at Low Risk for a Serious Bacterial Infection

Description

Kuppermann et al reported a clinical prediction rule for identifying a febrile infant at low risk for a serious bacterial infection. This can help to identify a patient who can be managed more conservatively. The authors are members of the Pediatric Emergency Care Applied Research Network (PECARN).

Patient selection: infant <= 60 days of age with fever (rectal temperature >= 38°C)

Outcome: absence of a serious bacterial infection (bacteremia, urinary tract infection, meningitis)

Parameters:

(1) urinalysis (leukocyte esterase, nitrite, pyuria with > 5 WBC per hpf)

(2) absolute neutrophil count per µL

(3) serum procalcitonin concentration in ng/mL

Parameter	Finding	Points
urinalysis	normal	1
	abnormal	0
absolute neutrophil count	<= 4,090 per µL	1
	> 4,090 per µL	0
serum procalcitonin concentration	<= 1.71 ng/mL	1
	> 1.71 ng/mL	0

total score =

= SUM(points for all 3 parameters)

Interpretation:

• minimum score: 0

• maximum score: 3

• A patient with a score of 3 is at low risk for a serious bacterial infection.

Performance:

• The negative predictive value was 99.6%.

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Clinical Prediction Rule of Kuppermann et al for Identifying a Febrile Infant at Low Risk for a Serious Bacterial Infection

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