| Title: |
Development and validation of a prediction model for invasive bacterial infections in febrile children at European Emergency Departments: MOFICHE a prospective observational study |
| Authors: |
Hagedoorn, N; Borensztajn, D; Nijman, R; Nieboer, D; Herberg, J; Balode, A; Von Both, U; Carroll, E; Eleftheriou, I; Emonts, M; Van Der Flier, M; De Groot, R; Kohlmaier, B; Lim, E; Maconochie, I; Martinon-Torres, F; Pokorn, M; Strle, F; Tsolia, M; Zavadska, D; Zenz, W; Levin, M; Vermont, C; Moll, H |
| Contributors: |
Wellcome Trust; European Commission; National Institute of Health and Medical Research |
| Source: |
647 ; 641 |
| Publisher Information: |
BMJ Publishing Group |
| Publication Year: |
2020 |
| Collection: |
Imperial College London: Spiral |
| Subject Terms: |
epidemiology; therapeutics; Pediatrics; 1103 Clinical Sciences; 1114 Paediatrics and Reproductive Medicine; 1117 Public Health and Health Services |
| Description: |
Objectives To develop and cross-validate a multivariable clinical prediction model to identify invasive bacterial infections (IBI) and to identify patient groups who might benefit from new biomarkers. Design Prospective observational study. Setting 12 emergency departments (EDs) in 8 European countries. Patients Febrile children aged 0–18 years. Main outcome measures IBI, defined as bacteraemia, meningitis and bone/joint infection. We derived and cross-validated a model for IBI using variables from the Feverkidstool (clinical symptoms, C reactive protein), neurological signs, non-blanching rash and comorbidity. We assessed discrimination (area under the receiver operating curve) and diagnostic performance at different risk thresholds for IBI: sensitivity, specificity, negative and positive likelihood ratios (LRs). Results Of 16 268 patients, 135 (0.8%) had an IBI. The discriminative ability of the model was 0.84 (95% CI 0.81 to 0.88) and 0.78 (95% CI 0.74 to 0.82) in pooled cross-validations. The model performed well for the rule-out threshold of 0.1% (sensitivity 0.97 (95% CI 0.93 to 0.99), negative LR 0.1 (95% CI 0.0 to 0.2) and for the rule-in threshold of 2.0% (specificity 0.94 (95% CI 0.94 to 0.95), positive LR 8.4 (95% CI 6.9 to 10.0)). The intermediate thresholds of 0.1%–2.0% performed poorly (ranges: sensitivity 0.59–0.93, negative LR 0.14–0.57, specificity 0.52–0.88, positive LR 1.9–4.8) and comprised 9784 patients (60%). Conclusions The rule-out threshold of this model has potential to reduce antibiotic treatment while the rule-in threshold could be used to target treatment in febrile children at the ED. In more than half of patients at intermediate risk, sensitive biomarkers could improve identification of IBI and potentially reduce unnecessary antibiotic prescriptions. |
| Document Type: |
article in journal/newspaper |
| Language: |
unknown |
| Relation: |
Archives of Disease in Childhood; http://hdl.handle.net/10044/1/85093; 097816/Z/11/ZR; 668303 |
| DOI: |
10.1136/archdischild-2020-319794 |
| Availability: |
http://hdl.handle.net/10044/1/85093; https://doi.org/10.1136/archdischild-2020-319794 |
| Rights: |
© Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY. Published by BMJ. https://creativecommons.org/licenses/by/4.0/This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See: https://creativecommons.org/licenses/by/4.0/. ; https://creativecommons.org/licenses/by/4.0/ |
| Accession Number: |
edsbas.56F51776 |
| Database: |
BASE |