Patient selection: infant from 29 to 56 days of age, rectal temperature >= 38.2°C
Parameters:
(1) white blood cell count
(2) white blood cell count in spun urine sediment in cells per high power field
(3) bacteria in spun uirne sediment
(4) cerebrospinal fluid white blood cell count
(5) Gram stain on cerebrospinal fluid
(6) lung infiltrate seen on chest X-ray
|
Parameter
|
Finding
|
Points
|
|
white blood cell count
|
< 15,000 per µL
|
0
|
|
|
>= 15,000 per µL
|
1
|
|
WBC in urine sediment
|
< 10 per high power field
|
0
|
|
|
>= 10 per high power field
|
1
|
|
bacteria in urine sediment
|
absent
|
0
|
|
|
present
|
1
|
|
CSF WBC
|
< 8 per µL
|
0
|
|
|
>= 8 per µL
|
1
|
|
CSF Gram stain
|
negative
|
0
|
|
|
positive
|
1
|
|
infiltrate on chest X-ray
|
absent
|
0
|
|
|
present
|
1
|
total score =
= SUM(points for all 6 parameters)
Interpretation:
• minimum score: 0
• maximum score: 6
• A score of 0 identiifed a group of infants at low risk for serious bacterial infection (SBI).
• A child at low risk for SBI can be managed without antibiotics. An infant managed as an outpatient should be re-examined at 24 and 48 hours.
Performance:
• A positive screening score was 98% sensitive and 42% specific.
• The positive predictive value was 14%. The negative predictive value was 99.7%.
