Development and validation of a prediction model for invasive bacterial infections in febrile children at European Emergency Departments : MOFICHE, a prospective observational study

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dc.contributor.authorHagedoorn, Nienke N.
dc.contributor.authorBorensztajn, Dorine
dc.contributor.authorNijman, Ruud Gerard
dc.contributor.authorNieboer, Daan
dc.contributor.authorHerberg, Jethro Adam
dc.contributor.authorBalode, Anda
dc.contributor.authorVon Both, Ulrich
dc.contributor.authorCarrol, Enitan
dc.contributor.authorEleftheriou, Irini
dc.contributor.authorEmonts, Marieke
dc.contributor.authorVan Der Flier, Michiel
dc.contributor.authorDe Groot, Ronald
dc.contributor.authorKohlmaier, Benno
dc.contributor.authorLim, Emma
dc.contributor.authorMacOnochie, Ian
dc.contributor.authorMartinón-Torres, Federico
dc.contributor.authorPokorn, Marko
dc.contributor.authorStrle, Franc
dc.contributor.authorTsolia, Maria
dc.contributor.authorZavadska, Dace
dc.contributor.authorZenz, Werner
dc.contributor.authorLevin, Michael
dc.contributor.authorVermont, Clementien
dc.contributor.authorMoll, Henriette A.
dc.contributor.institutionRīga Stradiņš University
dc.date.accessioned2021-10-07T08:30:01Z
dc.date.available2021-10-07T08:30:01Z
dc.date.issued2021-07-01
dc.descriptionFunding Information: Funding This project has received funding from the European Union’s Horizon 2020 research and innovation programme under grant agreement no. 668303. The research was supported by the National Institute for Health Research Biomedical Research Centres at Imperial College London, Newcastle Hospitals NHS Foundation Trust and Newcastle University. Publisher Copyright: © 2021 Archives of Disease in Childhood
dc.description.abstractObjectives: 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.en
dc.description.statusPeer reviewed
dc.format.extent779807
dc.identifier.citationHagedoorn, N N, Borensztajn, D, Nijman, R G, Nieboer, D, Herberg, J A, Balode, A, Von Both, U, Carrol, E, Eleftheriou, I, Emonts, M, Van Der Flier, M, De Groot, R, Kohlmaier, B, Lim, E, MacOnochie, I, Martinón-Torres, F, Pokorn, M, Strle, F, Tsolia, M, Zavadska, D, Zenz, W, Levin, M, Vermont, C & Moll, H A 2021, 'Development and validation of a prediction model for invasive bacterial infections in febrile children at European Emergency Departments : MOFICHE, a prospective observational study', Archives of Disease in Childhood, vol. 106, no. 7, pp. 641-647. https://doi.org/10.1136/archdischild-2020-319794
dc.identifier.doi10.1136/archdischild-2020-319794
dc.identifier.issn0003-9888
dc.identifier.otherMendeley: 7c275ded-7319-3c4b-9203-fc0d61216d1f
dc.identifier.urihttps://dspace.rsu.lv/jspui/handle/123456789/6581
dc.identifier.urlhttp://www.scopus.com/inward/record.url?scp=85096436459&partnerID=8YFLogxK
dc.language.isoeng
dc.relation.ispartofArchives of Disease in Childhood
dc.rightsinfo:eu-repo/semantics/openAccess
dc.subjectepidemiology
dc.subjecttherapeutics
dc.subject3.2 Clinical medicine
dc.subject1.1. Scientific article indexed in Web of Science and/or Scopus database
dc.subjectPediatrics, Perinatology, and Child Health
dc.titleDevelopment and validation of a prediction model for invasive bacterial infections in febrile children at European Emergency Departments : MOFICHE, a prospective observational studyen
dc.type/dk/atira/pure/researchoutput/researchoutputtypes/contributiontojournal/article

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