Chong et al reported the Febrile Infants Risk Score at Triage (FIRST) for identifying an infant with a serious bacterial infection. The FIRST+ score is determined after laboratory test results are available. The authors are from multiple institutions in Singapore and Duke-NUS Medical School.
Patient selection: febrile infant < 3 months old
Differences from FIRST score:
(1) removal of days of fever
(2) addition of laboratory tests (urine leukocyte esterase and serum procalcitonin)
Parameters:
(1) age in days
(2) temperature in °C
(3) sex
(4) urine leukocyte esterase
(5) serum procalcitonin in ng/mL
Parameter
Finding
Points
age in days
< 21 days
12
21 to 27.99 days
0
>= 28 days
16
temperature
< 38.5°C
0
38.5 to 38.9°C
1
39.0 to 39.9°C
6
>= 40°C
18
sex
female
0
male
9
urine leukocyte esterase
1+
13
2+
17
3+
36
negative
9
clinically not indicated
0
serum procalcitonin
< 0.05 ng/mL
0
0.05 to 0.35
2
0.36 to 4.37
8
>= 4.38
21
clinically not indicated
2
total score =
= SUM(points for all of the parameters)
Interpretation:
• minimum score: 0
• maximum score: 100
• The higher the score the greater the risk of a serious bacterial infection (SBI).
• A score >= 36 is associated with a 15% risk of SBI.
Performance:
• The area under the ROC curve is 0,87.
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