Bleeker et al reported models for predicting serious bacterial infection in a febrile child without obvious source of infection. An original clinical model was revised after subsequent studies. 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 vomiting
(3) clinical appearance
(4) chest wall retractions with or without tachypnea
(5) peripheral circulation
Parameter
Finding
Points
duration of fever
0.5 days
0
1
2
1.5
4
2 to 2.5
5
3 to 3.5
6
4 to 4.5
7
5 to 6
8
6.5 to 8.5
9
>= 9
10
history of vomiting
no
0
yes
5
appearance
ill
4
not ill appearing
0
chest retractions
no
0
yes
12
peripheral circulation
good to fair
0
poor
7
total score =
= SUM(points for all 5 parameters)
Interpretation:
• minimum score: 0
• maximum score: 38
• A clinical score <= 10 is associated with a 12% rate of serious bacterial infection.
• A clinical score > 10 is associated with a 42% rate of serious bacterial infection.
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