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. 2017 Jul;140(1):e20170695.
doi: 10.1542/peds.2017-0695. Epub 2017 Jun 6.

The Yale Observation Scale Score and the Risk of Serious Bacterial Infections in Febrile Infants

Lise E Nigrovic  1 , Prashant V Mahajan  2   3   4 , Stephen M Blumberg  5 , Lorin R Browne  6   7 , James G Linakis  3   8 , Richard M Ruddy  9 , Jonathan E Bennett  10 , Alexander J Rogers  3   4 , Leah Tzimenatos  3 , Elizabeth C Powell  11 , Elizabeth R Alpern  11   12 , T Charles Casper  13 , Octavio Ramilo  14 , Nathan Kuppermann  3   15 ; Febrile Infant Working Group of the Pediatric Emergency Care Applied Research Network (PECARN)
Affiliations

The Yale Observation Scale Score and the Risk of Serious Bacterial Infections in Febrile Infants

Lise E Nigrovic et al. Pediatrics. 2017 Jul.

Abstract

Objectives: To assess the performance of the Yale Observation Scale (YOS) score and unstructured clinician suspicion to identify febrile infants ≤60 days of age with and without serious bacterial infections (SBIs).

Methods: We performed a planned secondary analysis of a prospective cohort of non-critically ill, febrile, full-term infants ≤60 days of age presenting to 1 of 26 participating emergency departments in the Pediatric Emergency Care Applied Research Network. We defined SBIs as urinary tract infections, bacteremia, or bacterial meningitis, with the latter 2 considered invasive bacterial infections. Emergency department clinicians applied the YOS (range: 6-30; normal score: ≤10) and estimated the risk of SBI using unstructured clinician suspicion (<1%, 1%-5%, 6%-10%, 11%-50%, or >50%).

Results: Of the 4591 eligible infants, 444 (9.7%) had SBIs and 97 (2.1%) had invasive bacterial infections. Of the 4058 infants with YOS scores of ≤10, 388 (9.6%) had SBIs (sensitivity: 51/439 [11.6%]; 95% confidence interval [CI]: 8.8%-15.0%; negative predictive value: 3670/4058 [90.4%]; 95% CI: 89.5%-91.3%) and 72 (1.8%) had invasive bacterial infections (sensitivity 23/95 [24.2%], 95% CI: 16.0%-34.1%; negative predictive value: 3983/4055 [98.2%], 95% CI: 97.8%-98.6%). Of the infants with clinician suspicion of <1%, 106 had SBIs (6.4%) and 16 (1.0%) had invasive bacterial infections.

Conclusions: In this large prospective cohort of febrile infants ≤60 days of age, neither the YOS score nor unstructured clinician suspicion reliably identified those with invasive bacterial infections. More accurate clinical and laboratory predictors are needed to risk stratify febrile infants.

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Conflict of interest statement

POTENTIAL CONFLICT OF INTEREST: The authors have indicated they have no potential conflicts of interest to disclose.

Figures

FIGURE 1
FIGURE 1
Patient enrollment.
FIGURE 2
FIGURE 2
Receiver operator curves for YOS and unstructured clinician suspicion to distinguish between febrile infants with and without any SBI (A) or invasive bacterial infections (B).
See this image and copyright information in PMC

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