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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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