• About
  • Masthead
  • License Content
  • Advertise
  • Submit Press Release
  • RSS/Email List
  • Write for us
  • Contact us
2 Minute Medicine
No Result
View All Result

No products in the cart.

SUBSCRIBE
  • Specialties
    • Cardiology
    • Chronic Disease
    • Dermatology
    • Emergency
    • Endocrinology
    • Gastroenterology
    • Imaging and Intervention
    • Infectious Disease
    • Nephrology
    • Neurology
    • Obstetrics
    • Oncology
    • Ophthalmology
    • Pediatrics
    • Preclinical
    • Psychiatry
    • Public Health
    • Pulmonology
    • Rheumatology
    • Surgery
  • Wellness
  • Classics™
    • 2MM+ Online Access
    • Paperback and Ebook
  • Rewinds
  • Visual
  • Partners
    • License Content
    • Submit Press Release
    • Advertise with Us
  • AccountLog-in/out
    • Subscribe
    • Sign-in
    • My account
2 Minute Medicine
  • Specialties
    • Cardiology
    • Chronic Disease
    • Dermatology
    • Emergency
    • Endocrinology
    • Gastroenterology
    • Imaging and Intervention
    • Infectious Disease
    • Nephrology
    • Neurology
    • Obstetrics
    • Oncology
    • Ophthalmology
    • Pediatrics
    • Preclinical
    • Psychiatry
    • Public Health
    • Pulmonology
    • Rheumatology
    • Surgery
  • Wellness
  • Classics™
    • 2MM+ Online Access
    • Paperback and Ebook
  • Rewinds
  • Visual
  • Partners
    • License Content
    • Submit Press Release
    • Advertise with Us
  • AccountLog-in/out
    • Subscribe
    • Sign-in
    • My account
SUBSCRIBE
2 Minute Medicine
Subscribe
Home All Specialties Emergency

Clinical scale, clinician suspicion poorly predict serious infections

byMikhaela MontyandLeah Carr, MD
June 6, 2017
in Emergency, Infectious Disease, Pediatrics
Reading Time: 3 mins read
0
Share on FacebookShare on Twitter

1. In a prospective study of febrile full term infants 60 or fewer days old, neither the Yale Observation Scale (YOS) score nor unstructured clinician suspicion reliably identified infants with serious bacterial infections.

2. A YOS score < 10 had a high negative predictive value for serious bacterial infections, and even higher negative predictive value for invasive bacterial infections.

Evidence Rating Level: 1 (Excellent)      

Study Rundown: The most common reason an infant presents to the emergency department is fever. Of infants under 2 months of age who present with fever, 5 to 10% have serious bacterial infections. Despite extensive research, reliably identifying and treating febrile infants who are most likely suffering from serious bacterial infection is an ongoing challenge. This study assessed the sensitivity of the Yale Observation Scale (YOS) and compared its reliability to clinician suspicion in diagnosing serious bacterial infections (SBIs) in febrile infants 2 months of age or younger. Of those studied, almost 1 in 10 infants with YOS scores < 10 were found to have SBI (UTI, bacteremia, bacterial meningitis), and almost 2 out of every 100 were found to have invasive bacterial infection (bacteremia, bacterial meningitis). Over 5% of infants with clinician suspicion <1% were found to have SBI, and 1 out of 100 had invasive bacterial infection. Neither test was found to reliably identify infants with invasive bacterial infections or SBI. The results of this study emphasize the need for more accurate predictors of SBI among febrile infants to improve risk stratification. While this study underscores this urgency, it is limited by the exclusion of critically ill appearing infants.

Click to read the study in Pediatrics

Relevant Reading: Failure of infant observation scales in detecting serious illness in febrile, 4- to 8- week-old infants

In-Depth [prospective cohort study]: This study included 4591 febrile infants (mean age = 32.0 days, 56.5% male) less than or equal to 2 months in age, who presented to 1 of 26 emergency departments participating in the Febrile Infant Working Group of the Pediatric Emergency Care Applied Research Network (PECARN) between December 2008 and May 2013. Participating physicians received standardized training in applying the YOS scale, which utilized 6 observed behavioral domains and assigned infants a score from 6 (most well-appearing) to 30 (most ill-appearing). The same physicians were also asked to use their judgment and select 1 of 5 risk categories for SBI: <1%, 1-5%, 6-11%, 11-50% or >50%, which were described as “unstructured clinician suspicion”. Overall, infants with SBIs had similar median YOS scores compared to those without SBIs. Of 4058 infants with normal YOS scores, 9.6% had SBIs (n= 388), for a sensitivity of 11.6% and a negative predictive value (NPV) of 90.4%. Seventy-two infants with normal YOS scores had invasive bacterial infection, for a sensitivity of 24.2% and an NPV of 98.2%. Of infants with lowest clinician suspicion of SBI, 6.4% (n=106) had SBI and 1% (n=16) had invasive bacterial infections. YOS score did not discriminate between infants with or without SBI (area under the curve [AUC] 0.53, 95%CI 0.50-0.55), and had moderate ability to identify infants with invasive bacterial infection (AUC 0.61, 95% CI 0.56-0.67). Similarly, clinician suspicion had a modest ability to identify infants with SBI or invasive bacterial infection (AUC 0.61, 95% CI 0.58-0.63 and AUC 0.66, 95% CI 0.61-0.72, respectively). Neither assessment tool identified all 24 infants with true bacterial meningitis. On the contrary, 37.5% of infants with bacterial meningitis had a YOS score of 6.

RELATED REPORTS

Study highlights poor outcomes in very preterm infants with early-onset sepsis

Breastfeeding not associated with late-onset group B Streptococcus disease in infants

Wide variability in rate of antibiotic exposure among infants in NICU

Image: CC/Wiki/Nevit Dilmen 

©2017 2 Minute Medicine, Inc. All rights reserved. No works may be reproduced without expressed written consent from 2 Minute Medicine, Inc. Inquire about licensing here. No article should be construed as medical advice and is not intended as such by the authors or by 2 Minute Medicine, Inc.

Tags: neonatal feverneonatal sepsis
Previous Post

2 Minute Medicine Rewind June 5, 2017

Next Post

Liver cirrhosis linked to increased risk of hemorrhagic and ischemic stroke

RelatedReports

Quick Take: Analgesic efficacy and safety of morphine in the Procedural Pain in Premature Infants (Poppi) study: randomised placebo-controlled trial
Infectious Disease

Study highlights poor outcomes in very preterm infants with early-onset sepsis

September 9, 2021
Higher blood pressure targets in sepsis did not reduce mortality
Infectious Disease

Breastfeeding not associated with late-onset group B Streptococcus disease in infants

August 18, 2021
Racial, ethnic differences in outcomes of extremely preterm infants decreasing but persistent
Infectious Disease

Wide variability in rate of antibiotic exposure among infants in NICU

October 22, 2019
Herpes simplex virus infection uncommon in infants undergoing meningitis evaluation
Emergency

Herpes simplex virus infection uncommon in infants undergoing meningitis evaluation

January 3, 2018
Next Post
Intensive rehabilitation not superior to traditional therapy for arm function after stroke

Liver cirrhosis linked to increased risk of hemorrhagic and ischemic stroke

Pre-exposure prophylaxis (PrEP) effective in preventing HIV infection in high-risk gay men

Universal testing and treatment of HIV in East Africa led to improved coverage with antiretroviral therapy and improved viral suppression

Small and very small unruptured intracranial aneurysms may have little risk for rupture

Small and very small unruptured intracranial aneurysms may have little risk for rupture

License Our Award-Winning Physician-Written Medical News and Visual Abstracts

2 Minute Medicine is the leading authoritative medical news licensing service, and the only with reports written by practicing doctors.

LICENSE CONTENT

Get 2MM+ Premium Access

No ads & unlimited access to all current reports, over 9000 searchable archived reports, visual abstracts, Weekly Rewinds, and the online edition of The Classics Series™ textbook.

Subscription Options
2 Minute Medicine

2 Minute Medicine® is an award winning, physician-run, expert medical media company. Our content is curated, written and edited by practicing health professionals who have clinical and scientific expertise in their field of reporting. Our editorial management team is comprised of highly-trained MD physicians. Join numerous brands, companies, and hospitals who trust our licensed content.

Recent Reports

  • #VisualAbstract: Severe actinic keratosis and need for additional treatment are markers for an increased risk of cutaneous squamous cell carcinoma
  • Virtual yoga and meditation intervention may be associated with increased health-related quality of life
  • Wellness Check: Mental Health
License Content
Terms of Use | Disclaimer
Cookie Policy
Privacy Statement (EU)
Disclaimer

© 2021 2 Minute Medicine, Inc. - Physician-written medical news.

  • Specialties
    • Cardiology
    • Chronic Disease
    • Dermatology
    • Emergency
    • Endocrinology
    • Gastroenterology
    • Imaging and Intervention
    • Infectious Disease
    • Nephrology
    • Neurology
    • Obstetrics
    • Oncology
    • Ophthalmology
    • Pediatrics
    • Preclinical
    • Psychiatry
    • Public Health
    • Pulmonology
    • Rheumatology
    • Surgery
  • Wellness
  • Classics™
    • 2MM+ Online Access
    • Paperback and Ebook
  • Rewinds
  • Visual
  • Partners
    • License Content
    • Submit Press Release
    • Advertise with Us
  • Account
    • Subscribe
    • Sign-in
    • My account

© 2021 2 Minute Medicine, Inc. - Physician-written medical news.