Nguyen identified clinical findings associated with a low probability of an invasive bacterial infection in a child with fever and petechiae. No single screening test can identify a child at high-risk for serious bacterial infection but the presence of multiple normal findings can identify a child at low risk. The authors are from the State University of New York in Syracuse.
Patient selection: child with fever and petechiae (maximum age about 8 years according to Table 2)
Outcome: invasive bacterial infection (sepsis, meningitis, urinary tract infection, osteomyelitis, etc)
Criteria for low risk of invasive bacterial infection - all of the following:
(1) negative blood culture
(2) normal studies on cerebrospinal fluid (CSF) from lumbar puncture (see below)
(3) white blood cell count neither elevated nor depressed (in the range 4,500 to 15,000 per µL)
(4) normal band count (<= 500 per µL)
(5) normal absolute neutrophil count (in range 1,500 to 9,000 per µL)
(6) temperature <= 40°C
Abnormal CSF studies - one or more of the following:
(1) CSF glucose to blood glucose ratio < 50%
(2) CSF glucose < 25 mg/dL
(3) (CSF protein > 50 mg/dL) AND (not a neonate)
(4) (CSF LDH > 30 U/mL) AND (not a neonate)
(5) (CSF WBC count > 20 per µL) AND (not a neonate)
(6) positive Gram stain on CSF smear
(7) positive test for micro-organism (latex agglutination, etc)
The recent availability of molecular tests should help to better triage patients.
