Reappraisal of criteria used to predict serious bacterial illness in febrile infants less than 8 weeks of age
Reappraisal of criteria used to predict serious bacterial illness in febrile infants less than 8 weeks of age
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DOI：
10.1197/j.aem.2005.06.006
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发表时间：
2005-10-01
影响因子：
4.4
通讯作者：
Crain, EF
中科院分区：
文献类型：
--
作者：
Garra, G;Cunningham, SJ;Crain, EF
目标：重新评估费城方案和罗切斯特标准在新人群中识别严重细菌性疾病（SBI）低风险婴儿的价值。方法：作者前瞻性招募了56天或以下、直肠温度高于100.6华氏度的婴儿。医生分配了脓毒症的总体印象，并使用婴儿观察评分对每个婴儿进行客观评分。在病史和体格检查后，进行了完整的脓毒症评价。如果婴儿的血液、尿液、脑脊液或粪便培养物中有致病菌，则认为婴儿患有SBI。根据费城方案和罗切斯特标准，由一名对最终培养结果不知情的研究者将婴儿分为SBI的高风险组和低风险组。将该人群中Philadelphia方案和罗切斯特标准的试验性能参数与先前验证研究报告的参数进行比较。结果：181名婴儿被分配到危险组使用费城协议，259名婴儿使用罗切斯特标准。在该人群中，费城方案的阴性预测值（NPV）为97.1%（95%置信区间[95% CI]= 85.1%至99.8%），而原始报告中为99.7%，罗切斯特标准的NPV为97.3%（95% CI = 90.5%-99.2%），而之前报告的CI为98.9%。结论：费城方案和罗切斯特标准在应用于新的发热婴儿人群时，维持了其先前报告的NPV。这些数据说明了在新人群中重新测试临床决策规则的有用性，然后才被普遍接受。
Objective: To re-evaluate the Philadelphia protocol and the Rochester criteria for identifying infants at low risk for serious bacterial illness (SBI) in a new population. Methods: The authors prospectively enrolled infants 56 days of age or younger with rectal temperatures greater than 100.6 degrees F. Physicians assigned an overall impression of sepsis and objectively scored each infant using the Infant Observation Score. Following a history and physical examination, a complete sepsis evaluation was performed. Infants were considered to have SBI if their blood, urine, cerebrospinal fluid, or stool cultures grew pathogenic bacteria. Infants were assigned to high- and low-risk groups for SBI according to the Philadelphia protocol and the Rochester criteria by a single investigator blinded to the final culture results. The test performance parameters of the Philadelphia protocol and the Rochester criteria in this population were compared with those reported from previous validation studies. Results: One hundred eighty-one infants were assigned to risk groups using the Philadelphia protocol, and 259 infants using the Rochester criteria. In this population, the negative predictive value (NPV) of the Philadelphia protocol was 97.1% (95% confidence interval [95% CI] = 85.1% to 99.8%), compared with 99.7% in the original report, and the NPV of the Rochester criteria was 97.3% (95% CI = 90.5% to 99.2%), compared with a prior report of 98.9%. Conclusions: The Philadelphia protocol and the Rochester criteria maintained their previously reported NPVs when applied to a new population of febrile infants. These data illustrate the usefulness of retesting clinical decision rules in new populations prior to their universal acceptance.