Background
Objectives
Methods
Study design
Data collection
Inclusion criteria
High Risk Features | Intermediate Risk Features |
---|---|
Pale/mottled/ashen/blue skin, lips or tongue | Pallor of skin, lips or tongue reported by parent or carer |
No response to social cues | Not responding normally to social cues |
Appearing ill to a healthcare professional | No smile |
Does not wake or if roused does not stay awake | Wakes only with prolonged stimulation |
Weak, high-pitched or continuous cry | Decreased activity |
Grunting | Nasal flaring |
Respiratory rate greater than 60 breaths per minute | Dry mucous membranes |
Moderate or severe chest indrawing | Poor feeding in infants |
Reduced skin turgor | Reduced urine output |
Bulging fontanelle. | Rigors |
Exclusion criteria
Index test
Reference standards
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Urinary Tract Infection (UTI) – Growth of > 10,0000 cfu/ml of a single organism from either a single invasive sample (catheter or suprapubic aspiration) or two non-invasive samples.
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Bacterial gastroenteritis - Isolation of bacteria in stool.
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Pneumonia - Focal consolidation on chest radiograph confirmed by an experienced paediatric radiologist.
Statistical analysis
Ethical approval
Study registration
Results
Epidemiological & Clinical Data | |
---|---|
Male (%) | 51 |
Female (%) | 49 |
Age (Median and interquartile range), days | 42 (14–70) |
Median Temperature at Presentation (Median and interquartile range), °C | 37.4 (35.9–38.9) |
Parenteral Antibiotics, % | 27.8 |
Invasive Bacterial Infection, % (All E. coli Bacteraemia) | 3.2 |
Non-invasive Bacterial Infection, % (All Urinary Tract Infections) | 7.9% |
Diagnostic accuracy of procalcitonin testing for bacterial infections
PCT Cut-off 0.25 ng/ml | PCT Cut-off 0.5 ng/ml | PCT Cut-off 1.0 ng/ml | ||||
---|---|---|---|---|---|---|
Invasive Bacterial Infection | All Bacterial Infection | Invasive Bacterial Infection | All Bacterial Infection | Invasive Bacterial Infection | All Bacterial Infection | |
Sensitivity | 1.00 (0.40 to 1.00) | 0.86 (0.56 to 0.97) | 1.00 (0.40 to 1.00) | 0.86 (0.56 to 0.97) | 1.00 (0.40 to 1.00) | 0.86 (0.56 to 0.97) |
Specificity | 0.72 (0.63 to 0.80) | 0.77 (0.68 to 0.84) | 0.91 (0.84 to 0.95) | 0.97 (0.92 to 0.99) | 0.92 (0.85 to 0.96) | 0.98 (0.93 to 0.99) |
Positive Predictive Value | 0.11 (0.03 to 0.26) | 0.32 (0.18 to 0.49) | 0.27 (0.09 to 0.55) | 0.80 (0.51 to 0.95) | 0.29 (0.10 to 0.58) | 0.86 (0.56 to 0.97) |
Negative Predictive Value | 1.00 (0.95 to 1.00) | 0.98 (0.93 to 1.00) | 1.00 (0.96 to 1.00) | 0.98 (0.93 to 1.00) | 1.00 (0.96 to 1.00) | 0.98 (0.93 to 1.00) |
Comparison with laboratory CRP testing
CRP cut-off 20 mg/l | CRP cut-off 50 mg/l | CRP cut-off 100 mg/l | ||||
---|---|---|---|---|---|---|
Invasive Bacterial Infection | All Bacterial Infection | Invasive Bacterial Infection | All Bacterial Infection | Invasive Bacterial Infection | All Bacterial Infection | |
Sensitivity | 1.00 (0.40 to 1.00) | 0.93 (0.64 to 1.00) | 1.00 (0.40 to 1.00) | 0.62 (0.32 to 0.85) | 0.50 (0.01 to 0.91) | 0.21 (0.07 to 0.19) |
Specificity | 0.86 (0.78 to 0.92) | 0.94 (0.87 to 0.97) | 0.96 (0.89 to 0.98) | 0.99 (0.94 to 1.00) | 0.99 (0.95 to 1.00) | 1.00 (0.96 to 1.00) |
Positive Predictive Value | 0.20 (0.07 to 0.44) | 0.65 (0.41 to 0.84) | 0.44 (0.15 to 0.77) | 0.89 (0.51 to 0.99) | 0.67 (0.13 to 0.98) | 1.00 (0.31 to 1.00) |
Negative Predictive Value | 1.00 (0.95 to 1.00) | 0.99 (0.94 to 1.00) | 1.00 (0.96 to 1.00) | 0.96 (0.9 to 1.00) | 0.98 (0.93 to 1.00) | 0.91 (0.83 to 0.95) |