Predictors of Vorwerk et al for Identifying a Pediatric Patient with Severe Bacterial Infection Presenting to the Emergency Department

Description

Vorwerk et al identified a number of findings associated with severe bacterial infection in children presenting to the Emergency Department. These can help to identify a patient who may benefit from more aggressive management. The authors are from the University of Leicester and the Royal Infirmary Leicester.

Patient selection: age < 16 years with infection diagnosed in the Emergency Department

Parameters:

(1) venous serum lactate in mmol/L

(2) white blood cell count in 10^9/L

(3) serum C-reactive protein (CRP) in mg/L

Test	Optimal Cutoff	AUC ROC Curve
lactate	> 3.1 mmol/L	0.72
WBC count	> 14.1	0.67
CRP	> 20 mg/L	0.66

Test	Cutoff	Sensitivity	Specificity
lactate	>= 2.5 mmol/L	67%	66%
lactate	>= 4 mmol/L	38%	90%
WBC count	< 5 or >= 15	51%	74%
CRP	>= 50 mg/L	37%	84%

Combined	Sensitivity	Specificity
lactate >= 4 + WBC	22%	96%
lactate >= 4 + CRP	11%	98%
WBC + CRP	21%	92%

These tests have a relatively good specificity but only moderate sensitivity. The negative predictive values for single tests ranged from 93-96%.

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Predictors of Vorwerk et al for Identifying a Pediatric Patient with Severe Bacterial Infection Presenting to the Emergency Department

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