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Using AAP Guidelines for Managing Febrile Infants Without C-Reactive Protein and Procalcitonin.

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Title: Using AAP Guidelines for Managing Febrile Infants Without C-Reactive Protein and Procalcitonin.
Authors: Nguyen, Tran H. P., Young, Beverly R., Alabaster, Amy, Vinson, David R., Mark, Dustin G., Van Winkle, Patrick, Sharp, Adam L., Shan, Judy, Rauchwerger, Adina S., Greenhow, Tara L., Ballard, Dustin W.
Source: Pediatrics. Jan2023, Vol. 151 Issue 1, p1-11. 11p.
Subjects: Diagnosis of bacterial diseases, Blood, Bacteremia, Biomarkers, Hospital emergency services, Predictive tests, Fever, Cell culture, Confidence intervals, Inflammation, Operative surgery, Age distribution, Retrospective studies, Patients, Medical protocols, Bacterial meningitis, Emergency medical services, Descriptive statistics, Research funding, Sensitivity & specificity (Statistics), Blood cell count, Urinalysis, Diagnostic errors, American Academy of Pediatric Dentistry, Longitudinal method, Evaluation, Children
Geographic Terms: California
Abstract: BACKGROUND AND OBJECTIVES: In 2021, the American Academy of Pediatrics (AAP) published the Clinical Practice Guideline (CPG) for management of well-appearing, febrile infants 8 to 60 days old. For older infants, the guideline relies on several inflammatory markers, including tests not rapidly available in many settings like C-reactive protein (CRP) and procalcitonin (PCT). This study describes the performance of the AAP CPG for detecting invasive bacterial infections (IBI) without using CRP and PCT. METHODS: This retrospective cohort study included infants aged 8 to 60 days old presenting to Kaiser Permanente Northern California emergency departments between 2010 and 2019 with temperatures $38C who met AAP CPG inclusion criteria and underwent complete blood counts, blood cultures, and urinalyses. Performance characteristics for detecting IBI were calculated for each age group. RESULTS: Among 1433 eligible infants, there were 57 (4.0%) bacteremia and 9 (0.6%) bacterial meningitis cases. Using absolute neutrophil count >5200/mm3 and temperature >38.5C as inflammatory markers, 3 (5%) infants with IBI were misidentified. Sensitivities and specificities for detecting infants with IBIs in each age group were: 8 to 21 days: 100% (95% confidence interval [CI] 83.9%--100%) and 0% (95% CI 0%--1.4%); 22 to 28 days: 88.9% (95% CI 51.8%--99.7%) and 40.4% (95% CI 33.2%-- 48.1%); and 29 to 60 days: 93.3% (95% CI 77.9%--99.2%) and 32.1% (95% CI 29.1%-- 35.3%). Invasive interventions were recommended for 100% of infants aged 8 to 21 days; 58% to 100% of infants aged 22 to 28 days; and 0% to 69% of infants aged 29 to 60 days. CONCLUSIONS: When CRP and PCT are not available, the AAP CPG detected IBI in young, febrile infants with high sensitivity but low specificity. [ABSTRACT FROM AUTHOR]
Copyright of Pediatrics is the property of American Academy of Pediatrics and its content may not be copied or emailed to multiple sites without the copyright holder's express written permission. Additionally, content may not be used with any artificial intelligence tools or machine learning technologies. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)
Database: Psychology and Behavioral Sciences Collection
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PubType: Academic Journal
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  Data: <searchLink fieldCode="DE" term="%22Diagnosis+of+bacterial+diseases%22">Diagnosis of bacterial diseases</searchLink><br /><searchLink fieldCode="DE" term="%22Blood%22">Blood</searchLink><br /><searchLink fieldCode="DE" term="%22Bacteremia%22">Bacteremia</searchLink><br /><searchLink fieldCode="DE" term="%22Biomarkers%22">Biomarkers</searchLink><br /><searchLink fieldCode="DE" term="%22Hospital+emergency+services%22">Hospital emergency services</searchLink><br /><searchLink fieldCode="DE" term="%22Predictive+tests%22">Predictive tests</searchLink><br /><searchLink fieldCode="DE" term="%22Fever%22">Fever</searchLink><br /><searchLink fieldCode="DE" term="%22Cell+culture%22">Cell culture</searchLink><br /><searchLink fieldCode="DE" term="%22Confidence+intervals%22">Confidence intervals</searchLink><br /><searchLink fieldCode="DE" term="%22Inflammation%22">Inflammation</searchLink><br /><searchLink fieldCode="DE" term="%22Operative+surgery%22">Operative surgery</searchLink><br /><searchLink fieldCode="DE" term="%22Age+distribution%22">Age distribution</searchLink><br /><searchLink fieldCode="DE" term="%22Retrospective+studies%22">Retrospective studies</searchLink><br /><searchLink fieldCode="DE" term="%22Patients%22">Patients</searchLink><br /><searchLink fieldCode="DE" term="%22Medical+protocols%22">Medical protocols</searchLink><br /><searchLink fieldCode="DE" term="%22Bacterial+meningitis%22">Bacterial meningitis</searchLink><br /><searchLink fieldCode="DE" term="%22Emergency+medical+services%22">Emergency medical services</searchLink><br /><searchLink fieldCode="DE" term="%22Descriptive+statistics%22">Descriptive statistics</searchLink><br /><searchLink fieldCode="DE" term="%22Research+funding%22">Research funding</searchLink><br /><searchLink fieldCode="DE" term="%22Sensitivity+%26+specificity+%28Statistics%29%22">Sensitivity & specificity (Statistics)</searchLink><br /><searchLink fieldCode="DE" term="%22Blood+cell+count%22">Blood cell count</searchLink><br /><searchLink fieldCode="DE" term="%22Urinalysis%22">Urinalysis</searchLink><br /><searchLink fieldCode="DE" term="%22Diagnostic+errors%22">Diagnostic errors</searchLink><br /><searchLink fieldCode="DE" term="%22American+Academy+of+Pediatric+Dentistry%22">American Academy of Pediatric Dentistry</searchLink><br /><searchLink fieldCode="DE" term="%22Longitudinal+method%22">Longitudinal method</searchLink><br /><searchLink fieldCode="DE" term="%22Evaluation%22">Evaluation</searchLink><br /><searchLink fieldCode="DE" term="%22Children%22">Children</searchLink>
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  Data: <searchLink fieldCode="DE" term="%22California%22">California</searchLink>
– Name: Abstract
  Label: Abstract
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  Data: BACKGROUND AND OBJECTIVES: In 2021, the American Academy of Pediatrics (AAP) published the Clinical Practice Guideline (CPG) for management of well-appearing, febrile infants 8 to 60 days old. For older infants, the guideline relies on several inflammatory markers, including tests not rapidly available in many settings like C-reactive protein (CRP) and procalcitonin (PCT). This study describes the performance of the AAP CPG for detecting invasive bacterial infections (IBI) without using CRP and PCT. METHODS: This retrospective cohort study included infants aged 8 to 60 days old presenting to Kaiser Permanente Northern California emergency departments between 2010 and 2019 with temperatures $38C who met AAP CPG inclusion criteria and underwent complete blood counts, blood cultures, and urinalyses. Performance characteristics for detecting IBI were calculated for each age group. RESULTS: Among 1433 eligible infants, there were 57 (4.0%) bacteremia and 9 (0.6%) bacterial meningitis cases. Using absolute neutrophil count >5200/mm3 and temperature >38.5C as inflammatory markers, 3 (5%) infants with IBI were misidentified. Sensitivities and specificities for detecting infants with IBIs in each age group were: 8 to 21 days: 100% (95% confidence interval [CI] 83.9%--100%) and 0% (95% CI 0%--1.4%); 22 to 28 days: 88.9% (95% CI 51.8%--99.7%) and 40.4% (95% CI 33.2%-- 48.1%); and 29 to 60 days: 93.3% (95% CI 77.9%--99.2%) and 32.1% (95% CI 29.1%-- 35.3%). Invasive interventions were recommended for 100% of infants aged 8 to 21 days; 58% to 100% of infants aged 22 to 28 days; and 0% to 69% of infants aged 29 to 60 days. CONCLUSIONS: When CRP and PCT are not available, the AAP CPG detected IBI in young, febrile infants with high sensitivity but low specificity. [ABSTRACT FROM AUTHOR]
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  Data: <i>Copyright of Pediatrics is the property of American Academy of Pediatrics and its content may not be copied or emailed to multiple sites without the copyright holder's express written permission. Additionally, content may not be used with any artificial intelligence tools or machine learning technologies. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract.</i> (Copyright applies to all Abstracts.)
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RecordInfo BibRecord:
  BibEntity:
    Identifiers:
      – Type: doi
        Value: 10.1542/peds.2022-058495
    Languages:
      – Code: eng
        Text: English
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        PageCount: 11
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    Subjects:
      – SubjectFull: Diagnosis of bacterial diseases
        Type: general
      – SubjectFull: Blood
        Type: general
      – SubjectFull: Bacteremia
        Type: general
      – SubjectFull: Biomarkers
        Type: general
      – SubjectFull: Hospital emergency services
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      – SubjectFull: Predictive tests
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      – SubjectFull: Fever
        Type: general
      – SubjectFull: Cell culture
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      – SubjectFull: Confidence intervals
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      – SubjectFull: Inflammation
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      – SubjectFull: Operative surgery
        Type: general
      – SubjectFull: Age distribution
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      – SubjectFull: Retrospective studies
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      – SubjectFull: Patients
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      – SubjectFull: Medical protocols
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      – SubjectFull: Bacterial meningitis
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      – SubjectFull: Emergency medical services
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      – SubjectFull: Descriptive statistics
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      – SubjectFull: Research funding
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      – SubjectFull: Sensitivity & specificity (Statistics)
        Type: general
      – SubjectFull: Blood cell count
        Type: general
      – SubjectFull: Urinalysis
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      – SubjectFull: Diagnostic errors
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      – SubjectFull: American Academy of Pediatric Dentistry
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      – SubjectFull: Children
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      – SubjectFull: California
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