The yale observation scale score and the risk of serious bacterial infections in febrile infants

Lise E. Nigrovic, Prashant V. Mahajan, Stephen M. Blumberg, Lorin R. Browne, James G. Linakis, Richard M. Ruddy, Jonathan E. Bennett, Alexander J. Rogers, Leah S Tzimenatos, Elizabeth C. Powell, Elizabeth R. Alpern, T. Charles Casper, Octavio Ramilo, Nathan Kuppermann

Research output: Contribution to journalArticle

14 Citations (Scopus)

Abstract

OBJECTIVES: To assess the performance of the Yale Observation Scale (YOS) score and unstructured clinician suspicion to identify febrile infants ≤60 days of age with and without serious bacterial infections (SBIs). METHODS: We performed a planned secondary analysis of a prospective cohort of non-critically ill, febrile, full-term infants ≤60 days of age presenting to 1 of 26 participating emergency departments in the Pediatric Emergency Care Applied Research Network. We defined SBIs as urinary tract infections, bacteremia, or bacterial meningitis, with the latter 2 considered invasive bacterial infections. Emergency department clinicians applied the YOS (range: 6-30; normal score: ≤10) and estimated the risk of SBI using unstructured clinician suspicion (<1%, 1%-5%, 6%-10%, 11%-50%, or >50%). RESULTS: Of the 4591 eligible infants, 444 (9.7%) had SBIs and 97 (2.1%) had invasive bacterial infections. Of the 4058 infants with YOS scores of ≤10, 388 (9.6%) had SBIs (sensitivity: 51/439 [11.6%]; 95% confidence interval [CI]: 8.8%-15.0%; negative predictive value: 3670/4058 [90.4%]; 95% CI: 89.5%-91.3%) and 72 (1.8%) had invasive bacterial infections (sensitivity 23/95 [24.2%], 95% CI: 16.0%-34.1%; negative predictive value: 3983/4055 [98.2%], 95% CI: 97.8%-98.6%). Of the infants with clinician suspicion of <1%, 106 had SBIs (6.4%) and 16 (1.0%) had invasive bacterial infections. CONCLUSIONS: In this large prospective cohort of febrile infants ≤60 days of age, neither the YOS score nor unstructured clinician suspicion reliably identified those with invasive bacterial infections. More accurate clinical and laboratory predictors are needed to risk stratify febrile infants.

Original languageEnglish (US)
Article numbere20170695
JournalPediatrics
Volume140
Issue number1
DOIs
StatePublished - Jul 1 2017
Externally publishedYes

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Bacterial Infections
Fever
Observation
Confidence Intervals
Hospital Emergency Service
Bacterial Meningitides
Emergency Medical Services
Bacteremia
Urinary Tract Infections
Pediatrics

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health

Cite this

Nigrovic, L. E., Mahajan, P. V., Blumberg, S. M., Browne, L. R., Linakis, J. G., Ruddy, R. M., ... Kuppermann, N. (2017). The yale observation scale score and the risk of serious bacterial infections in febrile infants. Pediatrics, 140(1), [e20170695]. https://doi.org/10.1542/peds.2017-0695

The yale observation scale score and the risk of serious bacterial infections in febrile infants. / Nigrovic, Lise E.; Mahajan, Prashant V.; Blumberg, Stephen M.; Browne, Lorin R.; Linakis, James G.; Ruddy, Richard M.; Bennett, Jonathan E.; Rogers, Alexander J.; Tzimenatos, Leah S; Powell, Elizabeth C.; Alpern, Elizabeth R.; Casper, T. Charles; Ramilo, Octavio; Kuppermann, Nathan.

In: Pediatrics, Vol. 140, No. 1, e20170695, 01.07.2017.

Research output: Contribution to journalArticle

Nigrovic, LE, Mahajan, PV, Blumberg, SM, Browne, LR, Linakis, JG, Ruddy, RM, Bennett, JE, Rogers, AJ, Tzimenatos, LS, Powell, EC, Alpern, ER, Casper, TC, Ramilo, O & Kuppermann, N 2017, 'The yale observation scale score and the risk of serious bacterial infections in febrile infants', Pediatrics, vol. 140, no. 1, e20170695. https://doi.org/10.1542/peds.2017-0695
Nigrovic LE, Mahajan PV, Blumberg SM, Browne LR, Linakis JG, Ruddy RM et al. The yale observation scale score and the risk of serious bacterial infections in febrile infants. Pediatrics. 2017 Jul 1;140(1). e20170695. https://doi.org/10.1542/peds.2017-0695
Nigrovic, Lise E. ; Mahajan, Prashant V. ; Blumberg, Stephen M. ; Browne, Lorin R. ; Linakis, James G. ; Ruddy, Richard M. ; Bennett, Jonathan E. ; Rogers, Alexander J. ; Tzimenatos, Leah S ; Powell, Elizabeth C. ; Alpern, Elizabeth R. ; Casper, T. Charles ; Ramilo, Octavio ; Kuppermann, Nathan. / The yale observation scale score and the risk of serious bacterial infections in febrile infants. In: Pediatrics. 2017 ; Vol. 140, No. 1.
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abstract = "OBJECTIVES: To assess the performance of the Yale Observation Scale (YOS) score and unstructured clinician suspicion to identify febrile infants ≤60 days of age with and without serious bacterial infections (SBIs). METHODS: We performed a planned secondary analysis of a prospective cohort of non-critically ill, febrile, full-term infants ≤60 days of age presenting to 1 of 26 participating emergency departments in the Pediatric Emergency Care Applied Research Network. We defined SBIs as urinary tract infections, bacteremia, or bacterial meningitis, with the latter 2 considered invasive bacterial infections. Emergency department clinicians applied the YOS (range: 6-30; normal score: ≤10) and estimated the risk of SBI using unstructured clinician suspicion (<1{\%}, 1{\%}-5{\%}, 6{\%}-10{\%}, 11{\%}-50{\%}, or >50{\%}). RESULTS: Of the 4591 eligible infants, 444 (9.7{\%}) had SBIs and 97 (2.1{\%}) had invasive bacterial infections. Of the 4058 infants with YOS scores of ≤10, 388 (9.6{\%}) had SBIs (sensitivity: 51/439 [11.6{\%}]; 95{\%} confidence interval [CI]: 8.8{\%}-15.0{\%}; negative predictive value: 3670/4058 [90.4{\%}]; 95{\%} CI: 89.5{\%}-91.3{\%}) and 72 (1.8{\%}) had invasive bacterial infections (sensitivity 23/95 [24.2{\%}], 95{\%} CI: 16.0{\%}-34.1{\%}; negative predictive value: 3983/4055 [98.2{\%}], 95{\%} CI: 97.8{\%}-98.6{\%}). Of the infants with clinician suspicion of <1{\%}, 106 had SBIs (6.4{\%}) and 16 (1.0{\%}) had invasive bacterial infections. CONCLUSIONS: In this large prospective cohort of febrile infants ≤60 days of age, neither the YOS score nor unstructured clinician suspicion reliably identified those with invasive bacterial infections. More accurate clinical and laboratory predictors are needed to risk stratify febrile infants.",
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AU - Nigrovic, Lise E.

AU - Mahajan, Prashant V.

AU - Blumberg, Stephen M.

AU - Browne, Lorin R.

AU - Linakis, James G.

AU - Ruddy, Richard M.

AU - Bennett, Jonathan E.

AU - Rogers, Alexander J.

AU - Tzimenatos, Leah S

AU - Powell, Elizabeth C.

AU - Alpern, Elizabeth R.

AU - Casper, T. Charles

AU - Ramilo, Octavio

AU - Kuppermann, Nathan

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N2 - OBJECTIVES: To assess the performance of the Yale Observation Scale (YOS) score and unstructured clinician suspicion to identify febrile infants ≤60 days of age with and without serious bacterial infections (SBIs). METHODS: We performed a planned secondary analysis of a prospective cohort of non-critically ill, febrile, full-term infants ≤60 days of age presenting to 1 of 26 participating emergency departments in the Pediatric Emergency Care Applied Research Network. We defined SBIs as urinary tract infections, bacteremia, or bacterial meningitis, with the latter 2 considered invasive bacterial infections. Emergency department clinicians applied the YOS (range: 6-30; normal score: ≤10) and estimated the risk of SBI using unstructured clinician suspicion (<1%, 1%-5%, 6%-10%, 11%-50%, or >50%). RESULTS: Of the 4591 eligible infants, 444 (9.7%) had SBIs and 97 (2.1%) had invasive bacterial infections. Of the 4058 infants with YOS scores of ≤10, 388 (9.6%) had SBIs (sensitivity: 51/439 [11.6%]; 95% confidence interval [CI]: 8.8%-15.0%; negative predictive value: 3670/4058 [90.4%]; 95% CI: 89.5%-91.3%) and 72 (1.8%) had invasive bacterial infections (sensitivity 23/95 [24.2%], 95% CI: 16.0%-34.1%; negative predictive value: 3983/4055 [98.2%], 95% CI: 97.8%-98.6%). Of the infants with clinician suspicion of <1%, 106 had SBIs (6.4%) and 16 (1.0%) had invasive bacterial infections. CONCLUSIONS: In this large prospective cohort of febrile infants ≤60 days of age, neither the YOS score nor unstructured clinician suspicion reliably identified those with invasive bacterial infections. More accurate clinical and laboratory predictors are needed to risk stratify febrile infants.

AB - OBJECTIVES: To assess the performance of the Yale Observation Scale (YOS) score and unstructured clinician suspicion to identify febrile infants ≤60 days of age with and without serious bacterial infections (SBIs). METHODS: We performed a planned secondary analysis of a prospective cohort of non-critically ill, febrile, full-term infants ≤60 days of age presenting to 1 of 26 participating emergency departments in the Pediatric Emergency Care Applied Research Network. We defined SBIs as urinary tract infections, bacteremia, or bacterial meningitis, with the latter 2 considered invasive bacterial infections. Emergency department clinicians applied the YOS (range: 6-30; normal score: ≤10) and estimated the risk of SBI using unstructured clinician suspicion (<1%, 1%-5%, 6%-10%, 11%-50%, or >50%). RESULTS: Of the 4591 eligible infants, 444 (9.7%) had SBIs and 97 (2.1%) had invasive bacterial infections. Of the 4058 infants with YOS scores of ≤10, 388 (9.6%) had SBIs (sensitivity: 51/439 [11.6%]; 95% confidence interval [CI]: 8.8%-15.0%; negative predictive value: 3670/4058 [90.4%]; 95% CI: 89.5%-91.3%) and 72 (1.8%) had invasive bacterial infections (sensitivity 23/95 [24.2%], 95% CI: 16.0%-34.1%; negative predictive value: 3983/4055 [98.2%], 95% CI: 97.8%-98.6%). Of the infants with clinician suspicion of <1%, 106 had SBIs (6.4%) and 16 (1.0%) had invasive bacterial infections. CONCLUSIONS: In this large prospective cohort of febrile infants ≤60 days of age, neither the YOS score nor unstructured clinician suspicion reliably identified those with invasive bacterial infections. More accurate clinical and laboratory predictors are needed to risk stratify febrile infants.

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