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| Content Provider | World Health Organization (WHO)-Global Index Medicus |
|---|---|
| Author | Craig, Jonathan C. De, Sukanya Mccaskill, Mary Macaskill, Petra Isaacs, David Williams, Gabrielle J. Hayen, Andrew |
| Description | Author Affiliation: De S ( Screening and Test Evaluation Program, School of Public Health, University of Sydney, Sydney 2006, Australia. sukanya.de@health.nsw.gov.au); |
| Abstract | Objectives To determine the accuracy of a clinical decision rule (the traffic light system developed by the National Institute for Health and Clinical Excellence (NICE)) for detecting three common serious bacterial infections (urinary tract infection, pneumonia, and bacteraemia) in young febrile children. Design Retrospective analysis of data from a two year prospective cohort study Setting A paediatric emergency department. Participants 15 781 cases of children under 5 years of age presenting with a febrile illness. Main outcome measures Clinical features were used to categorise each febrile episodes as low, intermediate, or high probability of serious bacterial infection (green, amber, and red zones of the traffic light system); these results were checked (using standard radiological and microbiological tests) for each of the infections of interest and for any serious bacterial infection. Results After combination of the intermediate and high risk categories, the NICE traffic light system had a test sensitivity of 85.8% (95% confidence interval 83.6% to 87.7%) and specificity of 28.5% (27.8% to 29.3%) for the detection of any serious bacterial infection. Of the 1140 cases of serious bacterial infection, 157 (13.8%) were test negative (in the green zone), and, of these, 108 (68.8%) were urinary tract infections. Adding urine analysis (leucocyte esterase or nitrite positive), reported in 3653 (23.1%) episodes, to the traffic light system improved the test performance: sensitivity 92.1% (89.3% to 94.1%), specificity 22.3% (20.9% to 23.8%), and relative positive likelihood ratio 1.10 (1.06 to 1.14). Conclusion The NICE traffic light system failed to identify a substantial proportion of serious bacterial infections, particularly urinary tract infections. The addition of urine analysis significantly improved test sensitivity, making the traffic light system a more useful triage tool for the detection of serious bacterial infections in young febrile children. |
| ISSN | 09598138 |
| e-ISSN | 17561833 |
| Journal | BMJ (British Medical Journal) |
| Volume Number | 346 |
| Language | English |
| Publisher | British Medical Journal Publishing Group |
| Publisher Date | 2013-02-01 |
| Publisher Place | Great Britain (UK) |
| Access Restriction | Open |
| Subject Keyword | Bacterial Infections Diagnosis Decision Support Techniques Fever Microbiology Child, Preschool Diagnosis, Differential Emergency Service, Hospital Infant Infant, Newborn Predictive Value Of Tests ROC Curve Retrospective Studies Risk Assessment Sensitivity And Specificity Triage Research Support, Non-U.S. Gov't Medicine |
| Content Type | Text |
| Resource Type | Article |
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