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Randomized Controlled Trial
. 2014 Dec 11;9(12):e115061.
doi: 10.1371/journal.pone.0115061. eCollection 2014.

Impact of the lab-score on antibiotic prescription rate in children with fever without source: a randomized controlled trial

Laurence Lacroix  1 , Sergio Manzano  1 , Lynda Vandertuin  1 , Florence Hugon  1 , Annick Galetto-Lacour  1 , Alain Gervaix  1
Affiliations
Randomized Controlled Trial

Impact of the lab-score on antibiotic prescription rate in children with fever without source: a randomized controlled trial

Laurence Lacroix et al. PLoS One. .

Abstract

Background: The Lab-score, based on the combined determination of procalcitonin, C-reactive protein and urinary dipstick results, has been shown accurate in detecting serious bacterial infections (SBI) in children with fever without source (FWS) on retrospective cohorts. We aimed to prospectively assess the utility of the Lab-score in safely decreasing antibiotic prescriptions in children with FWS and to determine its diagnostic characteristics compared to common SBI biomarkers.

Methods: Randomized controlled trial in children 7 days to 36 months old with FWS, allocated either to the Lab-score group (Lab-score reported, blinded WBC count) or to the control group (WBC, bands and C-reactive protein determined, blinded procalcitonin and Lab-score), followed up until recovery. Demographic data, antibiotic prescription rate, admission rate and diagnostic properties of the Lab-score were analyzed.

Results: 271 children were analyzed. No statistically significant difference concerning antibiotic prescription rate was observed: 41.2% (54 of 131) in the Lab-score group and 42.1% (59 of 140) in the control group (p = 1.000). If recommendations based on the Lab-score had been strictly applied, a hypothetical 30.6% treatment rate would have been encountered, compared to the overall 41.7% observed rate (p = 0.0095). A Lab-score ≥3 showed the following characteristics: sensitivity 85.1% (95% CI: 76.5-93.6%), specificity 87.3% (95% CI: 82.7-91.8%), positive predictive value 68.7% (95% CI: 58.7-78.7%), negative predictive value 94.1% (95% CI: 91.5-97.9%), positive and negative likelihood ratios: 6.68 and 0.17 respectively. Area under the receiver operating characteristic curve was best for the Lab-score (0.911, 95% CI: 0.871-0.950).

Discussion: No difference regarding antibiotic treatment rate was observed when using the Lab-score, due to lack of adherence to the related recommendations. However, if strictly followed, a significant 26.5% reduction of antibiotic prescriptions would have been encountered. Medical education needs to be reinforced in order to observe rather than treat low-risk well-appearing children with FWS.

Trial registration: ClinicalTrials.gov NCT02179398.

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Conflict of interest statement

Competing Interests: The authors have thus provided an amended statement of competing interests that explicitly states that this commercial funder has no relationship relating to employment, consultancy, patents, products in development, marketed products, etc. with any of the authors. This does not alter the authors' adherence to all PLOS ONE policies on sharing data and materials, as detailed in the guide for authors (page 20, line 9-12).

Figures

Figure 1
Figure 1. Search results on CONSORT Flow Diagram (Consolidated Standards of Reporting Trials).
Figure 2
Figure 2. Receiver operating characteristic curve for Lab-score, PCT, CRP, WBC and band counts for SBI detection in children 0-3 years (A) and in children <3 months (B).
See this image and copyright information in PMC

References

    1. Baraff LJ (2000) Management of fever without source in infants and children. Ann Emerg Med 36:602–614. - PubMed
    1. Simon AE, Lukacs SL, Mendola P (2013) National trends in emergency department use of urinalysis, complete blood count, and blood culture for fever without a source among children aged 2 to 24 months in the pneumococcal conjugate vaccine 7 era. Pediatr Emerg Care 29:560–567. - PMC - PubMed
    1. Craig JC, Williams GJ, Jones M, Codarini M, Macaskill P, et al. (2010) The accuracy of clinical symptoms and signs for the diagnosis of serious bacterial infection in young febrile children: prospective cohort study of 15 781 febrile illnesses. BMJ 340:c1594. - PMC - PubMed
    1. McCarthy PL, Sharpe MR, Spiesel SZ, Dolan TF, Forsyth BW, et al. (1982) Observation scales to identify serious illness in febrile children. Pediatrics 70:802–809. - PubMed
    1. McCarthy PL, Lembo RM, Baron MA, Fink HD, Cicchetti DV (1985) Predictive value of abnormal physical examination findings in ill-appearing and well-appearing febrile children. Pediatrics 76:167–171. - PubMed

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