Field Testing the Utility of Procalcitonin and the Acute Infantile Observation Score in Febrile Infants 6 to 36 Months Old Presenting to the Pediatric Emergency Department With No Obvious Focus of Infection. (June 2013)

• Record Type: Journal Article
• Authors: Freyne, Bridget; Divilley, Ray; Kissoon-Harrison, Ghia; O'Neill, Michael B.
• Is Part Of: Clinical pediatrics. Volume 52:Number 6(2013)
• Page Start: 503
• Page End: 506
• Publication Date: 2013-06
• Subjects: procalcitonin -- AIOS -- serious bacterial Iilness -- emergency department; Pediatrics -- Periodicals; 618.920005
• DOI: 10.1177/0009922813483873
• Languages: English
• ISSNs: 0009-9228

Abstract

Background . Serious bacterial illness (SBI) presents a diagnostic challenge in febrile infants. History, clinical signs, and laboratory information combined with experiential knowledge affects decisions to admit and treat. Aim . To assess the utility of serum procalcitonin and the Acute Infantile Observation Score (AIOS) performed at emergency department presentation in predicting (a) confirmed serious bacterial illness and (b) illness severity. Methods . Sensitivity, specificity, and likelihood ratios were calculated for C-reactive protein, white cell count, serum procalcitonin, and AIOS. Results . Forty-six infants were recruited. Seven had a diagnosis of SBI, 28 were moderately ill with length of stay >24 hours, and 12 were severely ill with length of stay >96 hours. The positive likelihood ratios for confirmed SBI were C-reactive protein = 5.3, procalcitonin = 0.43, white cell count = 1.9, and AIOS = 1.5. Conclusion . Procalcitonin and the AIOS do not modify the diagnostic uncertainty of the ED physician assessing the febrile infant with respect to admission or antibiotic treatment above standard laboratory investigations.