et al. Herreros
Childrens Hospital of Philadelphia is a charitable 501(c)(3) nonprofit organization. Drafting of the manuscript: Kuppermann, Dayan, Mahajan. S, Gomez
Laupacis
Please fill out this brief <5 minute survey to guide WikEM's development of pediatric emergency resources: https://redcapynh.ynhh.org/surveys/?s=Y7J7DDHRTNNLFFPX. Interobserver agreement in the clinical assessment of children with blunt abdominal trauma. Identification of children at very low risk of clinically-important brain injuries after head trauma: a prospective cohort study. LF, Nawar
Statistical analysis: Kuppermann, Dayan, Miller, Casper, Mahajan. Enhanced urinalysis improves identification of febrile infants ages 60 days and younger at low risk for serious bacterial illness. Pediatric Emergency Care Applied Research Network (PECARN). Could we define a low risk cohort that could be screened in the ED and discharged with close follow up? Calculated Decisions: PECARN Rule for Low-Risk Febrile Infants Pediatr Emerg Care. Furthermore, although our sample included 170 patients with SBIs, only 30 had bacteremia or bacterial meningitis, reflecting the current epidemiology of SBIs in this age group. Serious bacterial infections were diagnosed in 170 infants (9.3%; 95% CI, 8.1-10.8), including 151 (8.3%; 95% CI, 7.1-9.6) with UTIs, 26 (1.4%; 95% CI, 1.0-2.1) with bacteremia, and 10 (0.5%; 95% CI, 0.3-1.0) with bacterial meningitis; 16 (0.9%; 95% CI, 0.5-1.4) had concurrent bacterial infections (eTable 2 in the Supplement). Kuppermann N, Dayan PS, Levine DA, et al. Woll
HHS Vulnerability Disclosure, Help Early postresuscitation hypotension is associated with increased mortality following pediatric cardiac arrest. Jain
Spirito A, Bromberg JR, Casper TC, et al. There was only a small number of patients with bacteremia and bacterial meningitis. P, Bonsu
Rhinovirus in febrile infants and risk of bacterial infection. Creating an infrastructure for safety event reporting and analysis in a multicenter pediatric emergency department network. PECARN Rule for Low Risk Febrile Infants 29-60 Days Old - MDCalc Baskin
2023 American Medical Association. Acad Emerg Med. Comparison of the test characteristics of procalcitonin to C-reactive protein and leukocytosis for the detection of serious bacterial infections in children presenting with fever without source: a systematic review and meta-analysis. A, Stein
I, Klein
Overall prevalence of SBI was 9.3% (170/1821); UTI was most common (8.3%), then bacteremia (1.4%), followed by meningitis (0.5%). S,
Recursive Partitioning Analysis, Table 2. Aronson
Association of RNA Biosignatures With Bacterial Infections in Febrile Infants Aged 60 Days or Younger. . B, Tobey
Herr
Only 1 of 153 (0.7%; 95% CI, 0.1%-3.6%) had an SBI (S aureus bacteremia). Similar to previous evaluations of prediction rules, our rule misclassified a few patients with SBIs. The decision tree retained 3 variables, urinalysis, ANC, and procalcitonin, that together identified a group of infants at low risk of SBI (Figure 2). Accessibility DW, Tham
P, Kuppermann
E. Ambulatory care of febrile infants younger than 2 months of age classified as being at low risk for having serious bacterial infections. 2019 Jul;144(1):e20183604. Importance
2011 Jan;39(1):141-149. Acad Emerg Med. 2009 Oct 3;374(9696):1160-1170. Acad Emerg Med. O, Allman
Stanley RM, Johnson MD, Vance C, et al. Yen K, Kuppermann N, Lillis K, Monroe D, Borgialli D, Kerrey BT, Sokolove PE, Ellison AM, Cook LJ, Holmes JF. Inj Epidemiol. Ann Emerg Med. A multicenter, randomized, controlled trial of dexamethasone for bronchiolitis. Cervical spine injury patterns in children. S, Gras-Le Guen
The study received institutional review board approval at each site, with permission for data sharing and material transfer. EF. Association of traumatic brain injuries with vomiting in children with blunt head trauma. Clinical observation frequently fails to identify infants with invasive bacterial infections (bacteremia and meningitis),8,9 and no single laboratory test result reliably identifies all infants with SBIs.6,10-19 Transcriptome analysis holds promise for earlier diagnosis20-23; however, these tests have not been fully evaluated in the clinical setting. The urinalysis, absolute neutrophil count, and serum procalcitonin levels may accurately identify febrile infants 60 days and younger at low risk for serious bacterial infections. Alessandrini E, Varadarajan K, Alpern ER, Gorelick MH, Shaw KN, Ruddy RM, Chamberlain JM, Pediatric Emergency Care Applied Research Network. Lee LK, Rogers AJ, Ehrlich PF, et al. ER. Vitals are within normal limits, patient is non-toxic and tolerated PO. J Trauma Acute Care Surg. et al. 2014 Jun;61(6):1049-1054. Singh
Acad Emerg Med. Pediatric diabetic ketoacidosis, fluid therapy and cerebral injury: the design of a factorial randomized controlled trial. 2006 Aug;32(4):299-303. PubMed Full text Clinical Question RW, Oudesluys-Murphy
Pediatric Emergency Care Applied Research Network (PECARN). Can clinical features and laboratory tests identify febrile infants 60 days and younger at low risk for serious bacterial infections? The Baby One | Nov Mesto Intravenous magnesium for pediatric sickle cell vaso-occlusive crisis: methodological issues of randomized controlled trial. Bronchiolitis: clinical characteristics associated with hospitalization and length of stay. Risk-stratification in febrile infants 29 to 60 days old: a cost et al; Pediatric Emergency Medicine Clinical Research Network (PEM CRC) Herpes Simplex Virus (HSV) Study Group. SA, Andreola
Kuppermann
The First AAP Clinical Practice Guideline for Febrile Infants | AAP We derived and validated an accurate prediction rule to identify febrile infants 60 days and younger at low risk for SBIs using 3 easily obtainable, objective variables: the urinalysis, the ANC, and serum procalcitonin. Leonard JC, Scharff DP, Koors V, Lerner EB, Adelgais KM, Anders J, Brown K, Babcock L, Lichenstein R, Lillis KA, Jaffe DM. 173 (4):342-351. EW. A, Lacroix
2005 Sep;8(3):141-153. Ann Emerg Med. CL, Enriquez
Pediatr Emerg Care. Infants 28 days may also be at risk for HSV which can have devastating consequences if missed. JF, Dayan
50 Other studies revealed lower rates of IBI but not statistically significantly lower. Urinary tract infection: clinical practice guideline for the diagnosis and management of the initial UTI in febrile infants and children 2 to 24 months. In a cohort of 1821 febrile infants 60 days and younger, 170 (9.3%) had serious bacterial infections, and using recursive partitioning analysis, we derived a low-risk prediction rule involving 3 variables: normal urinalysis, absolute neutrophil count 4090/L, and serum procalcitonin 1.71 ng/mL. The rule missed one patient with bacteremia, two with UTI, and none with meningitis. This study was supported in part by grant H34MCO8509 from Health Resources and Services Administration, Emergency Services for Children and by the Eunice Kennedy Shriver National Institute of Child Health and Human Development of the National Institutes of Health (grant R01HD062477). Bhatt M, Kennedy RM, Osmond MH, Krauss B, McAllister JD, Ansermino JM, Evered LM, Roback MG, Consensus Panel on Sedation Research of Pediatric Emergency Research Canada (PERC), Pediatric Emergency Care Applied Research Network (PECARN). We derived and validated a prediction rule based on these variables using binary recursive partitioning analysis. Acad Emerg Med. Published Online: February 18, 2019. doi:10.1001/jamapediatrics.2018.5501. Hernndez-Bou
When we compared multivariable logistic regression analysis with the recursive partitioning analysis, we found inferior test characteristics in the former. View Large Download. JAMA Pediatr. Identification of Long Bone Fractures in Radiology Reports Using Natural Language Processing to support Healthcare Quality Improvement. 2019. . FOIA The prediction rule identified infants at low risk of SBI using a negative urinalysis result, an ANC of 4090/L or less (to convert to 109 per liter, multiply by 0.001), and serum procalcitonin of 1.71 ng/mL or less. EJ, Fleisher
Targeted temperature management after pediatric cardiac arrest due to drowning: Outcomes and complications. 2009 Jul;37(7):2259-2267. Infant Fever Overview. Cruz
Clinical prediction rules with decision support can reduce variation in care and limit unnecessary interventions.26-29 However, many algorithms for the evaluation of febrile infants combine subjective clinical findings and laboratory markers using pre-existing numerical cutoffs rather than statistically derived values11,12,14,15,17,30 and lack precision and specificity, and validation studies have less than ideal accuracy.31-33 Biomarkers, such as C-reactive protein and procalcitonin, have been used either alone16,18,34-36 or combined with other laboratory and clinical findings32,37,38 to risk stratify febrile infants, but further assessment is necessary to identify optimal thresholds and determine their utility for inclusion in prediction rules. K, Faesch
BK,
2017 Jul;24(7):803-13. Jaskiewicz
2016 Sep 30. MD, Avner
2017 Jul;140(1). Management and outcomes of care of fever in early infancy. PL, Thurm
2012 Jan;19(1):70-78. CSF was obtained based on clinician discretion. Emergency physicians (faculty or fellows in general or pediatric emergency medicine) performed patient histories and physical examinations, provided assessment of the Yale Observation Scale (YOS) score,41 and recorded unstructured clinical suspicion of SBI (using 5 risk categories: <1%, 1%-5%, 6%-10%, 11%-50%, or >50%) prior to knowledge of laboratory results. This study is exciting, but I have some reservations. U, Jonasson
et al. Use of Traumatic Brain Injury Prediction Rules With Clinical Decision Support. Clinical prediction rules using biomarkers beyond the white blood cell count (WBC) may accurately identify febrile infants at low risk for SBIs. There were 908 in the derivation set, and it was internally validated in 913. [Epub ahead of print]. The PECARN rule low risk febrile infants 26-60 days of age has a 99.8% sensitivity for SBI. 2016 May;23(5):584-90. Pediatr Crit Care Med. The low risk prediction rule was based on three objective laboratory findings: Normal urinalysis Absolute neutrophil count 4,090/L TB, Bernzweig
Applications and methodological standards. Of 1266 infants aged 29 to 60 days, 776 (61.3%) were at low risk for the prediction rule, and 523 of these 776 (67.4%) had lumbar punctures performed. Blaschke
official website and that any information you provide is encrypted Use of procalcitonin assays to predict serious bacterial infection in young febrile infants. S, Zhu
Nigrovic
Development and implementation of a performance measure tool in an academic pediatric research network. If you have questions about any of the clinical pathways or about the process of creating a clinical pathway pleasecontact us. Febrile infants ages 29-90 days evaluated in US emergency departments (EDs) proceeded through the decision tree until they reached a terminal endpoint. 2012 Feb; 28(2):99-103. Would you like email updates of new search results? 2015 Feb; 12(1):67-76. PECARN Febrile Infant - WikEM Gomez
Febrile infants with high suspicion of herpes simplex virus (HSV) infection (eg, vesicles). Herberg
Alessandrini EA, Alpern ER, Chamberlain JM, Shea JA, Holubkov R, Gorelick MH, Pediatric Emergency Care Applied Research Network. Mahajan P, Alpern ER, Grupp-Phelan J, Chamberlain J, Dong L, Holubkov R, Jacobs E, Stanley R, Tunik M, Sonnett M, Miller S, Foltin GL, Pediatric Emergency Care Applied Research Network (PECARN). Transparent Reporting of a multivariable prediction model for Individual Prognosis or Diagnosis (TRIPOD): explanation and elaboration. Stanley R, Lillis K, Zuspan SJ, Lichenstein R, Ruddy RM, Gerardi MJ, Dean JM, Pediatric Emergency Care Applied Research Network (PECARN). Lerner EB, Dayan PS, Brown K, Fuchs S, Leonard J, Borgialli D, Babcock L, Hoyle JD Jr, Kwok M, Lillis K, Nigrovic LE, Mahajan P, Rogers A, Schwartz H, Soprano J, Tsarouhas N, Turnipseed S, Funai T, Foltin G, Pediatric Emergency Care Applied Research Network (PECARN). WE NEED YOU! et al. We compared descriptive statistics from patients enrolled in the parent study before procalcitonin levels were collected to the study cohort to detect any important differences. 2015 Apr; 22(4): 441-6. Presentations and outcomes of children with intraventricular hemorrhages after blunt head trauma. Pediatric Emergency Care Applied Research Network (PECARN). We have been trying to decipher the riddle of the young febrile infant for more than four decades. SBI indicates serious bacterial infection. Crit Care Med. Listed is descending order by year published. Pediatr Emerg Care. Pediatr Diabetes. SL, Dayan
Try the burgers, they are home made style." A paper titled " A Clinical Prediction Rule to Identify Febrile Infants 60 days and Younger at Low Risk for Serious Bacterial Infections " was published in JAMA Pediatrics in February of 2019. 2010 Feb;17(2):204-213. Acad Emerg Med. Our National Survey of Childrens Health (NSCH) now has 5 years of trend data. Browning B, Page KE, Kuhn RL, et al. This utilized rounded numbers: They found similar results with sensitivity 97.6%, specificity 61.1%, NPV 99.6%, negative LR 0.04. The sensitivity of the decision rule in the derivation set was 98.8% (95% CI, 92.5%-99.9%). Holmes JF, Borgialli DA, Nadel FM, Quayle KS, Schamban N, Cooper A, Schunk JE, Miskin ML, Atabaki SM, Hoyle JD, Dayan PS, Kuppermann N, TBI Study Group for the Pediatric Emergency Care Applied Research Network. Availability of pediatric emergency visit data from existing data sources. Role of the Funder/Sponsor: The funding organizations had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication. Prospective, observational study between March 2011 and May 2013 at 26 emergency departments. Laboratory errors in a pediatric emergency department network: An analysis of incident reports. B, Mintegi
Meert KL, Telford R, Holubkov R, et al. Ann Emerg Med. A new diagnosis grouping system for child emergency department visits. SS. Application of Transcriptional Signatures for Diagnosis of Febrile Infants Within the PECARN Network (TIG) The associations between potential predictors and SBI are shown in Table 2. Natale JE, Joseph JG, Rogers AJ, et al. L, Mahajan
Moler FW, Donaldson AE, Meert K, Brilli RJ, Nadkarni V, Shaffner DH, Schleien CL, Clark RS, Dalton HJ, Statler K, Tieves KS, Hackbarth R, Pretzlaff R, van der Jagt EW, Pineda J, Hernan L, Dean JM, Pediatric Emergency Care Applied Research Network (PECARN). 2016 Aug;23(8):878-84. Individual and Neighborhood Characteristics of Children Seeking Emergency Department Care for Firearm Injuries Within the PECARN Network. Serious bacterial infection was defined by bacterial meningitis, bacteremia, or UTI. Methods We developed a Markov decision model to estimate outcomes in well-appearing, febrile . Convenience sample of previously healthy febrile infants 60 days and younger who were evaluated for SBIs. A Clinical Prediction Rule to Identify Febrile Infants 60 Days and Younger at Low Risk for Serious Bacterial Infections. ER, Pitetti
J Pediatr. Cervical Spine Study Group for the Pediatric Emergency Care Applied Research Network (PECARN). 2007 Apr;14(4):e41-2. When applied to the new analytic cohort, the recursive partitioning analysis selected the same variables and numerical cutoffs, and the model had similar test accuracies (data not shown). Pediatrics. Risk of serious bacterial infection in young febrile infants with GR. Author Contributions: Dr Casper and Mr Miller had full access to study data and take responsibility for the integrity of the data and the accuracy of the data analysis. J,
C. Evaluation of the bedside Quikread go CRP test in the management of febrile infants at the emergency department. 2016 Apr;137(4). Natale JE, Joseph JG, Rogers AJ, Mahajan P, Cooper A, Wisner DH, Miskin ML, Hoyle JD Jr, Atabaki SM, Dayan PS, Holmes JF, Kuppermann N, PECARN (Pediatric Emergency Care Applied Research Network). Serious bacterial infection (defined as urinary tract infection, bacteremia, bacterial meningitis). Leonard JC, Jaffe DM, Olsen CS, Kuppermann N. Age-related differences in factors associated with cervical spine injuries in children. PL, Sharpe
Design, Setting, and Participants
Isolated loss of consciousness in children with minor blunt head trauma. Acad Emerg Med. et al; Febrile Infant Working Group for the Pediatric Emergency Care Applied Research Network (PECARN). Pediatrics. AM. This may affect confidence in application of this rule. Well appearing febrile infants - Don't Forget the Bubbles Lack of agreement in pediatric emergency visit discharge diagnoses from administrative and clinical data sources. Approximately, 10% of these patients will have a serious bacterial infection (SBI). 2015 May 14;372(20):1898-908. New PECARN Febrile Infant Rule: A 3-Variable - Academic Life in EM