Please use this identifier to cite or link to this item:
10.1136/archdischild-2020-319794
Title: | Development and validation of a prediction model for invasive bacterial infections in febrile children at European Emergency Departments : MOFICHE, a prospective observational study |
Authors: | Hagedoorn, Nienke N. Borensztajn, Dorine Nijman, Ruud Gerard Nieboer, Daan Herberg, Jethro Adam Balode, Anda Von Both, Ulrich Carrol, Enitan Eleftheriou, Irini Emonts, Marieke Van Der Flier, Michiel De Groot, Ronald Kohlmaier, Benno Lim, Emma MacOnochie, Ian Martinón-Torres, Federico Pokorn, Marko Strle, Franc Tsolia, Maria Zavadska, Dace Zenz, Werner Levin, Michael Vermont, Clementien Moll, Henriette A. Rīga Stradiņš University |
Keywords: | epidemiology;therapeutics;3.2 Clinical medicine;1.1. Scientific article indexed in Web of Science and/or Scopus database;Pediatrics, Perinatology, and Child Health |
Issue Date: | 1-Jul-2021 |
Citation: | Hagedoorn , 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 |
Abstract: | Objectives: 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. |
Description: | Funding 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 |
DOI: | 10.1136/archdischild-2020-319794 |
ISSN: | 0003-9888 |
Appears in Collections: | Research outputs from Pure / Zinātniskās darbības rezultāti no ZDIS Pure |
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