A predictive model to estimate the risk of serious bacterial infections in febrile infants
A predictive model to estimate the risk of serious bacterial infections in febrile infants
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DOI：
10.1007/bf01955183
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发表时间：
1996-06-01
影响因子：
3.6
通讯作者：
DerksenLubsen, G
中科院分区：
文献类型：
--
作者：
Berger, RMF;Berger, MY;DerksenLubsen, G
低风险标准已被定义为确定发热婴儿不太可能有严重的细菌感染（SBI）。使用这些标准，大约40%的发热婴儿可以被定义为低风险。在其余的婴儿（60%）中，只有10%-20%患有SBI。没有足够的标准来识别这些婴儿。前瞻性研究纳入了所有2周龄至1岁的婴儿，这些婴儿在1年期间直肠温度大于或等于38.0摄氏度。排除有早产史、围产期并发症、已知基础疾病、在前48小时内接受抗生素治疗或接种疫苗的婴儿。以SBI为因变量，采用多变量logistic回归模型对就诊时的临床和实验室变量进行评估。通过使用似然比的预测模型推导出，提供了一个测试后的概率SBI为每一个人的病人。在纳入研究的138名婴儿中，33名（24%）患有SBI。Logistic回归分析将C反应蛋白（CRP）、发热持续时间、标准化临床印象评分、腹泻史和局部感染体征作为SBI的独立预测因子。结论CRP、发热持续时间、“标准化临床印象评分”、腹泻史和局部感染体征是SBI的独立、最有力的预测因子。通过Logistic回归分析确定。虽然预测模型未被验证用于直接临床使用，但它说明了所用技术的临床潜力。这项技术提供了优势，以评估SBI的概率在每个单独的婴儿。这种可能性将构成在个别发热婴儿的管理中做出有根据的决定的最佳基础。
Low risk criteria have been defined to identify febrile infants unlikely to have serious bacterial infection (SBI). Using these criteria approximately 40% of all febrile infants can be defined as being at low risk. Of the remaining infants (60%) only 10%-20% have an SBI. No adequate criteria exists to identify these infants. All infants aged 2 weeks-1 year, presenting during a 1-year-period with rectal temperature greater than or equal to 38.0 degrees C to the Sophia Children's Hospital were included in a prospective study. Infants with a history of prematurity, perinatal complications, known underlying disease, antibiotic treatment or vaccination during the preceding 48 h were excluded. Clinical and laboratory variables at presentation were evaluated by a multivariate logistic regression model using SBI as the dependent variable. By using likelihood ratios a predictive model was derived, providing a post test probability of SBI for every individual patient. Of the 138 infants included in the study, 33 (24%) had SBI. Logistic regression analysis defined C-reactive protein (CRP), duration of fever, a standardized clinical impression score, a history of diarrhoea and focal signs of infection as independent predictors of SBI.Conclusion CRP, duration of fever, the ''standardized clinical impression score'', a history of diarrhoea and focal signs of infection were the independent, most powerful predictors of SBI in febrile infants, identified by logistic regression analysis. Although the predictive model is not validated for direct clinical use, it illustrates the clinical potential of the used technique. This technique offers the advantage to assess the probability of SBI in every individual infant. This probability will form the best basis for well-founded decisions in the management of the individual febrile infant.