Bleeker et al reported models for evaluating a febrile child without an obvious source of infection. One model is based on clinical findings. The authors are from Sophia Children's Hospital, University of Rotterdam, University Medical Centre Utrecht and Juliana Children's Hospital in The Hague.
Patient selection: child from 1 to 36 months, temperature >= 38.0°C, no apparent source after clinical evaluation
Outcome: diagnosis of serious bacterial infection
Parameters:
(1) duration of fever in days
(2) history of poor micturition
(3) history of vomiting
(4) age in years
(5) temperature in °C
(6) chest wall retractions with or without tachypnea
(7) peripheral circulation
Parameter
Finding
Points
duration of fever
0.5 to 1 day
1
1.5 to 2 days
2
2.5 to 4.5 days
3
5 to 8 days
4
>= 8.5 days
5
history poor micturition
no
0
yes
-3
history of vomiting
no
0
yes
4
age in years
<= 1 year
0
> 1 year
2
temperature
< 36.7°C
3
36.7 to 39.9 °C
0
>= 40°C
3
chest retractions
no
0
yes
8
peripheral circulation
good to fair
0
poor
2
score =
= SUM(points for all 7 parameters) + 2
Interpretation:
• minimum score: 0
• maximum score: 26
Score
Percent Serious Infection
0 to 7
10%
8 to 12
29%
13 to 26
67%
Performance:
• The area under the ROC curve is 0.75.
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