PECARN Febrile Infant - Revision history

Cole Ettingoff: /* Criticisms & Further Discussion */

2025-05-05T18:37:57Z

Criticisms & Further Discussion

← Older revision		Revision as of 18:37, 5 May 2025
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	==Criticisms & Further Discussion==		==Criticisms & Further Discussion==
	===Procalcitonin===		===[[Procalcitonin]]===
	Not all hospitals and emergency departments have access to procalcitonin testing. Additionally, procalcitonin results may not be available in a timely manner to help with decision-making.		Not all hospitals and emergency departments have access to procalcitonin testing. Additionally, procalcitonin results may not be available in a timely manner to help with decision-making.

	===Urinary Tract Infection Definition===		===[[Urinary Tract Infection]] Definition===
	This study used a lower threshold for determining UTI than the American Academy of Pediatric guidelines. The reason for this was because sometimes young infants have lower colonies of bacteria in urine but does make this prediction rule more conservative		This study used a lower threshold for determining UTI than the American Academy of Pediatric guidelines. The reason for this was because sometimes young infants have lower colonies of bacteria in urine but does make this prediction rule more conservative

Ostermayer at 13:13, 17 March 2023

2023-03-17T13:13:40Z

← Older revision		Revision as of 13:13, 17 March 2023
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	\| fulltexturl=https://jamanetwork.com/journals/jamapediatrics/fullarticle/2725042		\| fulltexturl=https://jamanetwork.com/journals/jamapediatrics/fullarticle/2725042
	\| pdfurl=		\| pdfurl=
			\| status = Complete
	}}		}}
	==Clinical Question==		==Clinical Question==

Rossdonaldson1 at 16:48, 15 March 2023

2023-03-15T16:48:48Z

← Older revision		Revision as of 16:48, 15 March 2023
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	===Procalcitonin===		===Procalcitonin===
	Not all hospitals and emergency departments have access to procalcitonin testing. Additionally, procalcitonin results may not be available in a timely manner to help with decision-making.		Not all hospitals and emergency departments have access to procalcitonin testing. Additionally, procalcitonin results may not be available in a timely manner to help with decision-making.

	===Urinary Tract Infection Definition===		===Urinary Tract Infection Definition===
	This study used a lower threshold for determining UTI than the American Academy of Pediatric guidelines. The reason for this was because sometimes young infants have lower colonies of bacteria in urine but does make this prediction rule more conservative		This study used a lower threshold for determining UTI than the American Academy of Pediatric guidelines. The reason for this was because sometimes young infants have lower colonies of bacteria in urine but does make this prediction rule more conservative

	===Young and Old Babies===		===Young and Old Babies===
	Most SBIs happened in the younger age group (≤28 days) compared to the older age group (>28 days). 13% vs 7.7%.		Most SBIs happened in the younger age group (≤28 days) compared to the older age group (>28 days). 13% vs 7.7%.

	===HSV===		===HSV===
	This study did not include viral testing. Infants ≤28 days may also be at risk for HSV which can have devastating consequences if missed. Be cautious in this age group.		This study did not include viral testing. Infants ≤28 days may also be at risk for HSV which can have devastating consequences if missed. Be cautious in this age group.

	===Low Prevalence of Disease===		===Low Prevalence of Disease===
	There was only a small number of patients with bacteremia and bacterial meningitis. This may affect confidence in application of this rule.		There was only a small number of patients with bacteremia and bacterial meningitis. This may affect confidence in application of this rule.

	===External Validation===		===External Validation===
	The PECARN team has presented results of an external validation of this clinical prediction rule at several conferences. This utilized rounded numbers:		The PECARN team has presented results of an external validation of this clinical prediction rule at several conferences. This utilized rounded numbers:

Rossdonaldson1: /* Major Points */

2023-03-15T16:48:12Z

Major Points

← Older revision		Revision as of 16:48, 15 March 2023
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	This rule was derived and validated in a multicenter PECARN study.		This rule was derived and validated in a multicenter PECARN study.
	They identified three laboratory criteria:		They identified three laboratory criteria:
	1)Normal urinalysis		#Normal urinalysis
	-presence of leukocyte esterase, nitrite, >5 WBCs		#*presence of leukocyte esterase, nitrite, >5 WBCs
	2)Absolute Neutrophil Count (ANC) ≤4090/µL		#Absolute Neutrophil Count (ANC) ≤4090/µL
	3)Serum procalcitonin ≤1.71 ng/mL		#Serum procalcitonin ≤1.71 ng/mL
	If all these criteria are met, the infant is at low risk of having SBI.		#*If all these criteria are met, the infant is at low risk of having SBI.

	==Study Design==		==Study Design==

Dennismr: Created page with "{{JC info | title=A Clinical Prediction Rule to Identify Febrile Infants 60 Days and Younger at Low Risk for Serious Bacterial Infections. | abbreviation= PECARN Low Risk Febrile Infant | expansion= Pediatric Emergency Care Applied Research Network Low Risk Febrile Infant | published=2019 | author=Kuppermann N. et al | journal=JAMA Pediatrics | year=2019 | volume=173 | issue=4 | pages=342-351 | pmid=30776077 | fulltexturl=https://jamanetwork.com/journals/jamapediatrics..."

2023-03-03T19:44:04Z

Created page with "{{JC info | title=A Clinical Prediction Rule to Identify Febrile Infants 60 Days and Younger at Low Risk for Serious Bacterial Infections. | abbreviation= PECARN Low Risk Febrile Infant | expansion= Pediatric Emergency Care Applied Research Network Low Risk Febrile Infant | published=2019 | author=Kuppermann N. et al | journal=JAMA Pediatrics | year=2019 | volume=173 | issue=4 | pages=342-351 | pmid=30776077 | fulltexturl=https://jamanetwork.com/journals/jamapediatrics..."

New page

{{JC info
| title=A Clinical Prediction Rule to Identify Febrile Infants 60 Days and Younger at Low Risk for Serious Bacterial Infections.
| abbreviation= PECARN Low Risk Febrile Infant
| expansion= Pediatric Emergency Care Applied Research Network Low Risk Febrile Infant
| published=2019
| author=Kuppermann N. et al
| journal=JAMA Pediatrics
| year=2019
| volume=173
| issue=4
| pages=342-351
| pmid=30776077
| fulltexturl=https://jamanetwork.com/journals/jamapediatrics/fullarticle/2725042
| pdfurl=
}}
==Clinical Question==
Can a clinical prediction rule using laboratory data identify febrile infants <60 days who are at low risk for serious bacterial infection or SBI (UTI, Bacteremia, Bacterial Meningitis) and reduce unnecessary lumbar punctures, antibiotics, and hospitalization?

==Conclusion==
This clinical decision rule based on urinalysis, absolute neutrophil count (ANC), and procalcitonin has a sensitivity of 97.7%, specificity of 60%, NPV of 99.6% and negative likelihood ratio of 0.04.

==Major Points==
This rule was derived and validated in a multicenter PECARN study.
They identified three laboratory criteria:
1)Normal urinalysis
-presence of leukocyte esterase, nitrite, >5 WBCs
2)Absolute Neutrophil Count (ANC) ≤4090/µL
3)Serum procalcitonin ≤1.71 ng/mL
If all these criteria are met, the infant is at low risk of having SBI.

==Study Design==
Prospective, observational study at 26 emergency departments between March 2011 and May 2013

==Population==
*N=1,821
*Derivation group: 908
*Validation group: 913

===Patient Demographics===
===Inclusion Criteria===
Febrile infants <60 days of age and had blood cultures obtained. Fever defined as rectal temp of ≥ 38°C in the ED, prior healthcare setting, or home within 24 hours.

===Exclusion Criteria===
Infants who were critically ill, had antibiotics in previous 48 hours, history of prematurity (≤26 weeks gestation), pre-existing medical conditions, indwelling devices or soft tissue infections.

==Interventions==
ED physicians (including fellows) performed history and physical exam, Yale Observation Scale, clinical suspicion of SBI. Blood and urine testing was obtained. CSF was obtained based on clinician discretion.

==Outcomes==
Serious bacterial infection (defined as urinary tract infection, bacteremia, bacterial meningitis)

UTI definition
*At least 1,000 cfu/mL for suprapubic aspiration samples
*At least 50,000 cfu/mL for catharized samples
*10,000-50,000 cfu/mL for catharized samples associated with abnormal UA

===Prediction Rule Characteristics===
*Normal urinalysis
*Absolute Neutrophil Count (ANC)≤4090/µL
*Serum procalcitonin ≤1.71 ng/mL

==Criticisms & Further Discussion==
===Procalcitonin===
Not all hospitals and emergency departments have access to procalcitonin testing. Additionally, procalcitonin results may not be available in a timely manner to help with decision-making.
===Urinary Tract Infection Definition===
This study used a lower threshold for determining UTI than the American Academy of Pediatric guidelines. The reason for this was because sometimes young infants have lower colonies of bacteria in urine but does make this prediction rule more conservative
===Young and Old Babies===
Most SBIs happened in the younger age group (≤28 days) compared to the older age group (>28 days). 13% vs 7.7%.
===HSV===
This study did not include viral testing. Infants ≤28 days may also be at risk for HSV which can have devastating consequences if missed. Be cautious in this age group.
===Low Prevalence of Disease===
There was only a small number of patients with bacteremia and bacterial meningitis. This may affect confidence in application of this rule.
===External Validation===
The PECARN team has presented results of an external validation of this clinical prediction rule at several conferences. This utilized rounded numbers:
*Negative UA
*ANC < 4000 /µL
*Procalcitonin <0.5 ng/mL
They found similar results with sensitivity 97.6%, specificity 61.1%, NPV 99.6%, negative LR 0.04. Publication is still pending.

==External Links==
*[https://www.aliem.com/pecarn-infant-fever-rule-age-29-60-days/ ALiEM PECARN Febrile Infant]
*[https://first10em.com/to-lp-or-not-lp-the-febrile-infant/ First10EM: To LP, or not to LP]
*[https://thesgem.com/2020/06/sgem296-shes-got-the-fever-but-does-she-need-an-lp-antibiotics-or-an-admission/ TheSGEM: She's Got the Fever]
*[https://rebelem.com/rebel-cast-episode-64-a-clinical-prediction-rule-for-febrile-infants-%E2%89%A460-days-at-low-risk-for-serious-bacterial-infections/ REBEL EM: A Clinical Prediction Rule for Febrile Infants]

==Funding==
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). This project was also supported in part by the Health Resources and Services Administration, Maternal and Child Health Bureau, Emergency Medical Services for ChildrenNetwork Development Demonstration Program under cooperative agreements U03MC00008, U03MC00001, U03MC00003, U03MC00006, U03MC00007, U03MC22684, and U03MC22685.

==References==
<references/>

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