Please use this identifier to cite or link to this item: https://doi.org/10.1371/journal.pone.0190649
Title: A retrospective review of vital signs and clinical outcomes of febrile infants younger than 3 months old presenting to the emergency department
Authors: Chong S.-L. 
Ong G.Y.-K. 
Chin W.Y.W.
Chua J.M.
Nair P.
Ong A.S.Z.
Ng K.C. 
Maconochie I.
Keywords: area under the curve
diagnostic test accuracy study
disease severity assessment
emergency ward
female
fever
heart rate
human
infant
infection
major clinical study
male
outcome assessment
Paediatric Canadian Triage and Acuity Scale
pediatric advanced life support
practice guideline
predictive value
reference value
retrospective study
Review
sensitivity and specificity
Severity Index Score
tertiary care center
vital sign
emergency health service
fever
hospital emergency service
newborn
outcome assessment
pathophysiology
Singapore
utilization
Emergency Service, Hospital
Fever
Humans
Infant
Infant, Newborn
Male
Outcome Assessment (Health Care)
Retrospective Studies
Singapore
Triage
Vital Signs
Issue Date: 2018
Publisher: Public Library of Science
Citation: Chong S.-L., Ong G.Y.-K., Chin W.Y.W., Chua J.M., Nair P., Ong A.S.Z., Ng K.C., Maconochie I. (2018). A retrospective review of vital signs and clinical outcomes of febrile infants younger than 3 months old presenting to the emergency department. PLoS ONE 13 (1) : e0190649. ScholarBank@NUS Repository. https://doi.org/10.1371/journal.pone.0190649
Abstract: Objectives Febrile infants younger than 3 months old present a diagnostic dilemma to the emergency physician. We aim to describe a large population of febrile infants less than 3 months old presenting to a pediatric emergency department (ED) and to assess the performance of current heart rate guidelines in the prediction of serious infections (SI). Materials and methods We performed a retrospective review of febrile infants younger than 3 months old, between March 2015 and Feb 2016, in a large tertiary pediatric ED. We documented the primary outcome of SI for each infant, as well as the clinical findings, vital signs, and Severity Index Score (SIS). We assessed the performance of the Paediatric Canadian Triage and Acuity Scale (PaedCTAS), Advanced Pediatric Life Support (APLS) guidelines and Fleming normal reference values, using sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and area under receiver operating characteristics curve (AUC). Results 1057 infants were analyzed, with 326 (30.6%) infants diagnosed with SI. High temperature, tachycardia, and low SIS score were significantly associated with SI. Item analysis showed that the SIS performance was driven by the presence of mottling (p = 0.003) and high temperature (p<0.001). The APLS guideline had the highest sensitivity (66.0%, 95% CI 60.5–71.1%), NPV (73.3%, 95% CI 69.7–76.5%) and AUC (0.538), while the PaedCTAS (2 standard deviation from normal) had the highest specificity (98.5%, 95% CI 97.3–99.3%) and PPV (55.2%, 95% CI 32.7–71.0%). Conclusions Current guidelines on infantile heart rates have a variable performance. In our study, the APLS heart rate guidelines performed with the highest sensitivity, but no individual guideline predicted for SIs satisfactorily. © 2018 Chong et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Source Title: PLoS ONE
URI: https://scholarbank.nus.edu.sg/handle/10635/165766
ISSN: 1932-6203
DOI: 10.1371/journal.pone.0190649
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