Garro A, Chodobski A, Szmydynger-Chodobska J, et al. The associations between potential predictors and SBI are shown in Table 2. Project Revise. Whats the Risk of VTE After Minor Surgery? Mahajan B, Hernndez-Bou Finally, we performed a multivariable logistic regression analysis to determine whether this would result in a more accurate model. One thousand eight hundred six infants (99.2%) had CBCs, 1775 (97.5%) had urinalyses, and 1399 (76.8%) had lumbar punctures performed (including 871 of 1266 infants aged 29-60 days [68.8%]). Hoyle JD Jr, Callahan JM, Badawy M, Powell E, Jacobs E, Gerardi M, Melville K, Miskin M, Atabaki SM, Dayan P, Holmes JF, Kuppermann N, Traumatic Brain Injury Study Group for the Pediatric Emergency Care Applied Research Network (PECARN). Clinical Decision Support for a Multicenter Trial of Pediatric Head Trauma: Development, Implementation, and Lessons Learned. Management of febrile neonates in US pediatric emergency departments. Pediatr Emerg Care. aThis includes patients for whom procalcitonin (PCT) could not be sampled, regardless of whether an eligible RNA biosignature sample was obtained in the parent study. AR, Chang Can clinical features and laboratory tests identify febrile infants 60 days and younger at low risk for serious bacterial infections? Crit Care Med. 2009 Nov;25(11):715-720. P, Kuppermann Other model test characteristics are reported in Figure 2. 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). Overall classification counts and characteristics are shown for both the derivation and validation cohorts below the classification tree. Dayan PS, Lillis K, Bennett J, Conners G, Bailey P, Callahan J, Akman C, Feldstein N, Hauser WA, Kuppermann N, Pediatric Emergency Department Northeast Team of the PECARN. Anticipated resource utilization for injury versus non-injury pediatric visits to emergency departments. Epidemiology of bacteremia in febrile infants in the United States. Ann Emerg Med. Baskin 2017; 140 . Epub 2019 Jun 5. [epub ahead of print]. Risk of SBIs With Further Subdivision of High ANC Group by PCT Level (Full Cohort), eFigure 6. Crit Care Med. R. Procalcitonin in young febrile infants for the detection of serious bacterial infections. Bennett KS, Clark AE, Meert L, Topjian AA, Schleien CL, Shaffner DH, Dean JM, Moler FW, Pediatric Emergency Care Applied Research Network. 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. Pediatr Blood Cancer. Prevalence of clinically important traumatic brain injuries in children with minor blunt head trauma and isolated sever injury mechanisms. VJ, Appl Clin Inform. DA, et al; Febrile Infant Working Group of the Pediatric Emergency Care Applied Research Network (PECARN). Influenza virus infection and the risk of serious bacterial infections in young febrile infants. To derive and validate a prediction rule to identify febrile infants 60 days and younger at low risk for SBIs. In the derivation set of 908 infants with a rate of SBI of 9.0%, a negative urinalysis, ANC of 4090/L or lower (to convert to 109 per liter, multiply by 0.001), and a serum procalcitonin level of 1.71 ng/mL or lower identified a low-risk group of 522 infants, with an SBI risk of 0.2% (1 infant). Importantly, the rule does not require CSF data, potentially obviating the need for routine lumbar punctures for many young febrile infants provided that further external validation confirms accuracy. FR, Hoff Chamberlain JM, Shaw KN, Lillis KA, Mahajan PV, Ruddy RM, Lichenstein R, Olsen CS, Dean JM, Pediatric Emergency Care Applied Research Network. et al. BK, Chb . L, Friedman To identify a low-risk cohort using the derivation set, all potential predictors of SBI were entered into a binary recursive partitioning analysis.53 The algorithm identifies optimal thresholds for each numerical predictor to generate decision trees. 2016 May;23(5):566-75. 2013 Aug;12(347):f4836. The Yale Observation Scale score and the risk of serious bacterial infections in febrile infants. Dalziel SR, Thompson JM, Macias CG, Fernandes RM, Johnson DW, Waisman Y, Cheng N, Acworth J, Chamberlain JM, Osmond MH, Plint A, Valerio P, Black KJ, Fitzpatrick E, Newton AS, Kuppermann N, Klassen TP, Pediatric Emergency Research Networks H1N1 Working Group. 2012 Apr;28(4):307-309. The PECARN Pediatric Head Injury/Trauma Algorithm provides the PECARN algorithm for evaluating pediatric head injury. The current analytic cohort includes patients enrolled during the first and second grant cycles, between March 2011 and May 2013. IMPORTANT This calculator is not yet externally validated. Accepted for Publication: December 4, 2018. 2009 Aug;124(2):485-493. Four patients had herpes simplex virus infections (all were hospitalized). 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). C, Alpern Fever may be the only sign of infection in young infants with SBIs. Alessandrini E, Varadarajan K, Alpern ER, Gorelick MH, Shaw KN, Ruddy RM, Chamberlain JM, Pediatric Emergency Care Applied Research Network. Zonfrillo MR, Macy ML, Cook LJ, et al. Radiologic safety events within a pediatric emergency medicine network. For now, I think these children still need a full workup, including LP. New landmark in risk-stratifying infant feverThe PECARN group derived and internally validated a new infant fever prediction rule in 26 EDs around the US. As noted in the Supplement, alternative cutoffs for ANC (4,000) and procalcitonin (0.5) were studied and found to be comparable to the published cutoffs in terms of accuracy. 173 (4):342-351. Pediatric Emergency Care Applied Research Network (PECARN). Objective Interobserver agreement in retrospective chart reviews for factors associated with cervical spine injuries in children. We also performed a sensitivity analysis to account for uncertain diagnoses of UTIs in patients with colony counts of 10000 to 49999 cfu/hpf and abnormal urinalysis results. Yo 2007 Apr;14(4):e41-2. EW. RK, Goldman A, Weiss Menaker J, Blumberg S, Wisner DH, et al. J, Perlman Lichenstein R, Monroe D, Quayle KS, et al. Acad Emerg Med. Calculated Decisions: Rochester Criteria for Febrile Infants. SBI indicates serious bacterial infection. Sickle cell working group of the Pediatric Emergency Care Applied Research Network (PECARN). JAMA. MR, Spiesel Jain 2007 Jun;14(6):532-538. Prehos Emerg Care. 2014 Feb;21(2):171-179. Pediatr Emerg Care. Priorities for pediatric prehospital research. McCaig Wasson 2017 Mar;18(2):95-102. A multi-center randomized controlled trial of intravenous magnesium for sickle cell pain crisis in children. Development, evaluation and implementation of chief complaint groupings to activate data collection: A multi-center study of clinical decision support for children with head trauma. Huppler Clin Trials. Methods for Collecting Paired Observations from Emergency Medical Services and Emergency Department Providers for Pediatric Cervical Spine Injury Risk Factor. 2016 Apr;137(4). Failure of infant observation scales in detecting serious illness in febrile, 4- to 8-week-old infants. Pediatric Emergency Care Applied Research Network. 2011 Jan;39(1):141-149. Applying outpatient protocols in febrile infants 1-28 days of age: can the threshold be lowered? Statistical analysis: Kuppermann, Dayan, Miller, Casper, Mahajan. Acad Emerg Med. DA, Platt infants. Objective: Pediatrics. Do children with blunt head trauma and normal cranial computed tomography scan results require hospitalization for neurologic observation? Overall prevalence of SBI was 9.3% (170/1821); UTI was most common (8.3%), then bacteremia (1.4%), followed by meningitis (0.5%). 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). About 14 out of every 1,000 healthy infants born full term develop a fever during the ages 8 days to 60 days old. Dayan PS, Holmes JF, Atabaki S, Hoyle J Jr, Tunik MG, Lichenstein R, Alpern E, Miskin M, Kuppermann N, Traumatic Brain Injury Study Group of the Pediatric Emergency Care Applied Research Network (PECARN). PECARN Rule for Low Risk Febrile Infants 29-60 Days Old Predicts risk of urinary tract infection, bacteremia, or bacterial meningitis in febrile infants age 29-60 days old. DePorre PL, Sharpe They identified three laboratory criteria: Prospective, observational study at 26 emergency departments between March 2011 and May 2013. Isolated loss of consciousness in children with minor blunt head trauma. Intra-abdominal Injury Study Group of the Pediatric Emergency Care Applied Research Network (PECARN). Roberts Once further validated on an independent cohort, clinical application of the rule has the potential to decrease unnecessary lumbar punctures, antibiotic administration, and hospitalizations. Diagnostic accuracy of the urinalysis for urinary tract infection in infants <3 months of age. Pediatr Crit Care Med. Meaning 2014 Jan;21(1):55-64. We enrolled patients based on research coordinator availability; however, rates of specific SBIs were similar to prior studies in similar populations,3-5 suggesting that the enrolled sample was representative. N Engl J Med. 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. PubMed Full text Clinical Question Atabaki SM, Hoyle JD Jr, Schunk JE, et al. 2013 Aug;20(8):795-800. In the validation cohort, the rule sensitivity was 97.7% (95% CI, 91.3-99.6), specificity was 60.0% (95% CI, 56.6-63.3), negative predictive value was 99.6% (95% CI, 98.4-99.9), and negative likelihood ratio was 0.04 (95% CI, 0.01-0.15). See 51 photos from 460 visitors about hoegaarden, draft beer, and stella artois. Incidental findings in children with blunt head trauma evaluated with cranial CT scans. HA, Loveridge Low-risk infants evaluated with the PECARN clinical prediction rule had a 0.52% risk of having a missed UTI and 0.79% risk of having missed bacteremia. Therapeutic Hypothermia after Pediatric Cardiac Arrest Trial Investigators. Kadish 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). B, Mintegi This rule was derived and validated in a multicenter PECARN study. et al; HSV Study Group of the Pediatric Emergency Medicine Collaborative Research Committee. For details, see the eResults in the Supplement. This study used a lower threshold for determining UTI than the American Academy of Pediatric guidelines. Obtained funding: Kuppermann, Dean, Ramilo, Mahajan. ED physicians (including fellows) performed history and physical exam, Yale Observation Scale, clinical suspicion of SBI. van Rossum R, Murray Exposures S, Gomez 2014 Jun;42(6): 1518-23. 1 The authors sought to derive a new clinical prediction rule for infants with fever. (2021, May 3). 2015 Apr; 22(4): 441-6. Clinical and laboratory data (blood and urine) including patient demographics, fever height and duration, clinical appearance, WBC, absolute neutrophil count (ANC), serum procalcitonin, and urinalysis. RD, Choi J Trauma Acute Care Surg. et al; Febrile Young Infant Research Collaborative. Chamberlain JM, Singh T, Baren JM, Maio RF; Pediatric Emergency Care Applied Research Network. Kuppermann N, Holmes JF, Dayan PS, Hoyle JD, Atabaki SM, Holubkov R, Nadel FM, Monroe D, Stanley RM, Borgialli DA, Badawy MK, Schunk JE, Quayle KS, Mahajan P, Lichenstein R, Lillis KA, Tunik MG, Jacobs ES, Callahan JM, Gorelick MH, Glass TF, Lee LK, Bachman MC, Cooper A, Powell EC, Gerardi MJ, Melville KA, Muizelaar JP, Wisner DH, Zuspan SJ, Dean JM, Wootton-Gorges SL, Pediatric Emergency Care Applied Research Network (PECARN). M. Predicting the outcome of neonatal bacterial meningitis. Pediatrics. Listed is descending order by year published. 2009 Jul;37(7):2259-2267. When we compared multivariable logistic regression analysis with the recursive partitioning analysis, we found inferior test characteristics in the former. Herberg Pediatr Diabetes. Shaw KN, Lillis KA, Ruddy RM, Mahajan PV, Lichenstein R, Olsen CS, Chamberlain JM, Pediatric Emergency Care Applied Research Network. Acad Emerg Med. Scarfone SI conversion factor: To convert absolute neutrophil count (ANC) to 109 per liter, multiply by 0.001. We derived and validated a prediction rule based on these variables using binary recursive partitioning analysis. Infants from whom blood cultures were obtained for evaluation of SBIs during times when research staff were available were eligible (Figure 1). Recursive Partitioning Analysis, Table 2. B, Martinez-Virumbrales Before Data were analyzed between April 2014 and April 2018. 2015 May 14;372(20):1898-908. 2003 Jun:19:185-193. G, Cunningham Stanley RM, Johnson MD, Vance C, et al. 2015 Aug 19;6(3):521-35;eCollection 2015. 2011 Jun;127(6):1067-1073. Glass T, Ruddy RM, Alpern ER, et al. Pediatr Emerg Care. Carter PM, Cook LJ, Macy ML, et al. The effect of observation on cranial computed tomography utilization for children after blunt head trauma. "A Clinical Prediction Rule to Identify Febrile Infants 60 Days and Younger at Low Risk for Serious Bacterial Infections.". E, Evans Appl Clin Inform. 2014 Dec;165(6):1201-6.e2. doi:10.1001/jamapediatrics.2018.5501. A, Sekar A review and suggested modifications of methodological standards. Rationale, timeline, study design and protocol overview of the therapeutic hypothermia after pediatric cardiac arrest trials. Bethesda, MD 20894, Web Policies Clinical care was at the discretion of the treating clinician. LM, Avner This utilized rounded numbers: They found similar results with sensitivity 97.6%, specificity 61.1%, NPV 99.6%, negative LR 0.04. Pediatric Emergency Care Applied Research Network (PECARN). PCT indicates procalcitonin; SBI, serious bacterial infection. E. Ambulatory care of febrile infants younger than 2 months of age classified as being at low risk for having serious bacterial infections. 2016 Aug 23-30;316(8):846-57. We prioritized the sensitivity of the prediction rule by specifying a relative cost of 100 to 1 for failure to identify an SBI vs incorrectly predicting SBI. Mahajan P, Kuppermann N, Tunik M, et al. Pediatric Emergency Care Applied Research Network (PECARN). doi: 10.1016/j.jped.2015.06.004. We derived and validated an accurate prediction rule to identify febrile infants 60 days and younger at low risk for SBIs using the urinalysis, ANC, and procalcitonin levels. P, Kuppermann Emerg Med J. Case Presentations A 20-day-old boy presents to the ED in August for evaluation of a rectal temperature of 38C (100.4F). F. Lumbar puncture for all febrile infants 29-56 days old: a retrospective cohort reassessment study. Risk stratification of febrile infants 60 days old without routine lumbar puncture. K, Faesch Mahajan P, Ramilo O, Kupperman N. The future possibilites of diagnostic testing for the evaluation of febrile infants. S, Gomez Macy ML, Zonfrillo MR, Cook LJ, et al. Kerrey BT, Rogers AJ, Lee LK, Adelgais K, Tunik M, Blumberg SM, Quayle KS, Sokolove PE, Wisner DH, Miskin ML, Kuppermann N, Holmes JF, Pediatric Emergency Care Applied Research Network. DW, Tham et al. Pediatr Emerg Care. Methods L, Gervaix Pediatr Emerg Care. Singh O, Benito Meert KL, Telford R, Holubkov R, et al. Family burden after out-of-hospital cardiac arrest in children. [Epub ahead of print]. Most SBIs happened in the younger age group (28 days) compared to the older age group (>28 days). et al; Pediatric Emergency Medicine Clinical Research Network (PEM CRC) Herpes Simplex Virus (HSV) Study Group. Natale JE, Joseph JG, Rogers AJ, et al. Klinger First, many centers dont have a rapid procalcitonin assay. Prevalence of Brain Injuries and Recurrence of Seizures in Children With Posttraumatic Seizures. This site needs JavaScript to work properly. J Pediatr. Bressan However, a repeated blood culture prior to antibiotic administration was negative, and the patient was treated with antibiotics with an uneventful course. Our National Survey of Childrens Health (NSCH) now has 5 years of trend data. [Epub ahead of print]. Leonard JC, Jaffe DM, Olsen CS, Kuppermann N. Age-related differences in factors associated with cervical spine injuries in children. CN, Beyene Pediatr Crit Care Med. Badawy MK, Dayan PS, Tunik MG, et al. Follow-up information for these patients was based on observation in the hospital (n=178), telephone follow-up (n=216), or medical record review (n=44). Use of oral contrast for abdominal computed tomography in children with blunt torso trauma. J Pediatr. C, Neuman Identifying febrile infants at risk for a serious bacterial infection. Multivariable Logistic Regression Analysis. We derived the prediction rule on a random sample of 908 infants and validated it on 913 infants (mean age was 36 days, 765 were girls [42%], 781 were white and non-Hispanic [43%], 366 were black [20%], and 535 were Hispanic [29%]). Rounding the numerical thresholds of the ANC and serum procalcitonin to easier-to-apply numbers resulted in nearly identical model test characteristics. SM, Wald PV, Blumberg M, Wright CA, Richardson 2015 Oct;33(10):1458-64. Dagan 2013 Aug;132(2):356-363. CHOP is not responsible for any errors or omissions in the clinical pathways, or for any outcomes a patient might experience where a clinician consulted one or more such pathways in connection with providing care for that patient. Shaw KN, Ruddy RM, Olsen CS, Lillis KA, Mahajan PV, Dean JM, Chamberlain JM, Pediatric Emergency Care Applied Research Network (PECARN). The Pediatric Emergency Care Applied Research Network (PECARN): ratoinale, development, and first steps. Pediatric Blood and Cancer. CHOP does not represent or warrant that the clinical pathways are in every respect accurate or complete, or that one or more of them apply to a particular patient or medical condition. Comparison of outcomes for children with cervical spine injury based on destination hospital from scene of injury. Unable to load your collection due to an error, Unable to load your delegates due to an error. Immature neutrophils in the blood smears of young febrile children. Pediatr Emerg Care. The PECARN rule for low-risk febrile infants predicts the risk for urinary tract infection, bacteremia, or bacterial meningitis in febrile infants aged 60 days. Diagnostic performance of the lab-score in predicting severe and invasive bacterial infections in well-appearing young febrile infants. Performance of low-risk criteria in the evaluation of young infants with fever: review of the literature.
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