Performance of Febrile Infant Decision Tools on Hypothermic Infants Evaluated for Infection

Author:

Westphal Kathryn12,Adib Hania3,Doraiswamy Vignesh12,Basiago Kevin3,Lee Jennifer4,Banker Sumeet L.4,Morrison John56,McCartor Saylor7,Berger Stephanie8,Schmit Erinn O.8,Van Meurs Annalise9,Mitchell Meredith10,Lee Clifton10,Wood Julie K.11,Tapp Lauren G.11,Kunkel Deborah12,Halvorson Elizabeth E.11,Potisek Nicholas M.711,

Affiliation:

1. aDivision of Hospital Medicine, Nationwide Children’s Hospital, Columbus, Ohio

2. bDepartment of Pediatrics, The Ohio State University College of Medicine, Columbus, Ohio

3. cDepartment of Pediatrics, Keck School of Medicine of USC, Children’s Hospital Los Angeles, Los Angeles, California

4. dDepartment of Pediatrics, Columbia University Vagelos College of Physicians and Surgeons and New York-Presbyterian, New York, New York

5. eDivision of Pediatric Hospital Medicine, Johns Hopkins All Children’s Hospital, St. Petersburg, Florida

6. fDepartment of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland

7. gDepartment of Pediatrics, University of South Carolina School of Medicine Greenville, Prisma Health Children’s Hospital-Upstate, Greenville, South Carolina

8. hDepartment of Pediatrics, University of Alabama at Birmingham Heersink School of Medicine, Birmingham, Alabama

9. iDepartment of Pediatrics, Oregon Health and Science University, Doernbecher Children’s Hospital, Portland, Oregon

10. jDepartment of Pediatrics, Children’s Hospital of Richmond at Virginia Commonwealth University, Richmond, Virginia

11. kDepartment of Pediatrics, Wake Forest University School of Medicine, Winston-Salem, North Carolina

12. lSchool of Mathematical and Statistical Sciences, Clemson University, Clemson, South Carolina

Abstract

BACKGROUND Given the lack of evidence-based guidelines for hypothermic infants, providers may be inclined to use febrile infant decision-making tools to guide management decisions. Our objective was to assess the diagnostic performance of febrile infant decision tools for identifying hypothermic infants at low risk of bacterial infection. METHODS We conducted a secondary analysis of a retrospective cohort study of hypothermic (≤36.0 C) infants ≤90 days of age presenting to the emergency department or inpatient unit among 9 participating sites between September 1, 2016 and May 5, 2021. Well-appearing infants evaluated for bacterial infections via laboratory testing were included. Infants with complex chronic conditions or premature birth were excluded. Performance characteristics for detecting serious bacterial infection (SBI; urinary tract infection, bacteremia, bacterial meningitis) and invasive bacterial infection (IBI; bacteremia, bacterial meningitis) were calculated for each tool. RESULTS Overall, 314 infants met the general inclusion criteria, including 14 cases of SBI (4.5%) and 7 cases of IBI (2.2%). The median age was 5 days, and 68.1% of the infants (214/314) underwent a full sepsis evaluation. The Philadelphia, Boston, IBI Score, and American Academy of Pediatrics Clinical Practice Guideline did not misclassify any SBI or IBI as low risk; however, they had low specificity and positive predictive value. Rochester and Pediatric Emergency Care Applied Research Network tools misclassified infants with bacterial infections. CONCLUSIONS Several febrile infant decision tools were highly sensitive, minimizing missed SBIs and IBIs in hypothermic infants. However, the low specificity of these decision tools may lead to unnecessary testing, antimicrobial exposure, and hospitalization.

Publisher

American Academy of Pediatrics (AAP)

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