The Step-by-Step approach can be used to triage a young (<= 90 day old) febrile infant. The authors are from multiple institutions in Europe.
Patient inclusion: febrile (temperature >= 38°C) infant <= 90 days old without source of infection
Exclusions: clear source of fever identified, no fever in ED, no objective evidence of fever at home
Outcome: invasive bacterial infection
High risk patient:
(1) abnormal pediatric assessment triangle (ill-appearing)
(2) age <= 21 days
(3) leukocyturia
(4) procalcitonin >= 0.5 ng/mL
Intermediate risk patient:
(1) CRP > 20 mg/L
(2) absolute neutrophil count > 10,000 per µL
Low risk patient: everyone else
Performance for identifying an invasive bacterial infection:
• In the study by Gomez et al the e sensitivity is 92% and specificity is 47%, with a claimed negative predictive value of 99%.
