단일기관 응급실에서 시행한 90일 미만 발열 환자에 대한 Step-by-Step approach의 후향적 타당도평가
Retrospective validation of the Step-by-Step approach for febrile infants younger than 90 days in the emergency department
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Abstract
Purpose To retrospectively validate the Step-by-Step approach, a sequential algorithm for prediction of serious bacterial infections (SBI) using the appearance, age, and inflammatory markers, in febrile infants younger than 90 days. Methods The presence of SBI was reviewed in febrile infants younger than 90 days undergoing blood and urine cultures (using perineal adhesive bags), assays for procalcitonin, C-reactive protein and absolute neutrophil count, and urinalysis at the emergency department from September 2015 through August 2017. The low-risk infants were classified according to the Step-by-Step approach. SBI was defined as urinary tract infection (UTI), bacteremia or meningitis. We measured the sensitivity and negative predictive value (NPV) of the approach in predicting SBI, and compared the values to those of the Rochester criteria and the Lab-score. Results Of 488 febrile infants (44.7% underwent lumbar puncture), 71 (14.5%) had SBI, including 67 UTI, 5 bacteremia, and 3 meningitis (mutually inclusive). Of 208 low-risk infants (42.6%), no SBI was found. The Step-by-Step approach showed a 100% sensitivity (95% confidence interval [CI]: 94.9-100.0) and NPV (95% CI: not applicable). The Rochester criteria showed a 98.6% sensitivity (95% CI: 92.4-100.0) and 99.6% NPV (95% CI: 97.1-99.9), and missed 1 meningitis. The Lab-score showed a 59.2% sensitivity (95% CI: 46.8-70.7) and 93.2% NPV (95% CI: 91.2-94.8), and missed 2 meningitis and 27 UTI. Conclusion The Step-by-Step approach showed a 100% sensitivity and NPV in predicting SBI. This approach may help predict SBI without lumbar puncture in febrile infants younger than 90 days.
참고문헌 (20)
- Baker MD, "Outpatient management without antibiotics of fever in selected infants", N Engl J Med, 329, pp.1437~141 (1993)
- Greenhow TL, "Management and outcomes of previously healthy, full-term, febrile infants ages 7 to 90 days", Pediatrics, 138, pp.e20160270~ (2016)
- Greenhow TL, "Bacteremia in children 3 to 36 months old after introduction of conjugated pneumococcal vaccines", Pediatrics, 139, pp.e20162098~ (2017)
- Greenhow TL, "The changing epidemiology of serious bacterial infections in young infants", Pediatr Infect Dis J, 33, pp.595~599 (2014)
- Chua KP, "Association between clinical outcomes and hospital guidelines for cerebrospinal fluid testing in febrile infants aged 29-56days", J Pediatr, 167, pp.1340~1346.e9 (2015)
- Scarfone R, "Lumbar puncture for all febrile infants 29-56 days old: a retrospective cohort reassessment study", J Pediatr, 187, pp.200~205.e1 (2017)
- Mintegi S, "Accuracy of a sequential approach to identify young febrile infants at low risk for invasive bacterial infection", Emerg Med J, 31, pp.e19~e24 (2014)
- Jaskiewicz JA, "Febrile infants at low risk for serious bacterial infection: an appraisal of the Rochester criteria and implications for management", Pediatrics, 94, pp.390~396 (1994), Febrile Infant Collaborative Study Group
- Gomez B, "Validation of the “Step-by-Step” approach in the management of young febrile infants", Pediatrics, 138, pp.e20154381~ (2016)
- Wallace SS, "Prevalence of concomitant acute bacterial meningitis in neonates with febrile urinary tract infection: a retrospective cross-sectional study", J Pediatr, 184, pp.199~203 (2017)
- Seung Joo Lee, "Clinical Guideline for Childhood Urinary Tract Infection (Second Revision)", Childhood Kidney Diseases, 19(2), pp.56~64 (2015), 대한소아신장학회
- Lacour AG, "A score identifying serious bacterial infections in children with fever without source", Pediatr Infect Dis J, 27, pp.654~656 (2008)
- Bonadio W, "Pediatric lumbar puncture and cerebrospinal fluid analysis", J Emerg Med, 46, pp.141~150 (2014)
- 정재원, "소아기 및 청소년기의 환아들에서 요추 천자 후의 부작용", 대한소아신경학회지, 17(2), pp.192~199 (2009), 대한소아신경학회
- Martinez E, "Prevalence and predictors of bacterial meningitis in young infants with fever without a source", Pediatr Infect Dis J, 34, pp.494~498 (2015)
- Verbakel JY, "Sepsis and meningitis in hospitalized children: performance of clinical signs and their prediction rules in a case-control study", Pediatr Emerg Care, 30, pp.373~380 (2014)
- Aronson PL, "Variation in care of the febrile young infant <90 days in US pediatric emergency departments", Pediatrics, 134, pp.667~677 (2014)
- Subcommittee on Urinary Tract Infection, "Urinary tract infection: clinical practice guideline for the diagnosis and management of the initial UTI in febrile infants and children 2 to 24 months", Pediatrics, 128, pp.595~610 (2011)
- Deis JN, "Procalcitonin as a marker of severe bacterial infection in children in the emergency department", Pediatr Emerg Care, 26, pp.51~60 (2010)
- Dandona P, "Procalcitonin increase after endotoxin injection in normal subjects", J Clin Endocrinol Metab, 79, pp.1605~1608 (1994)