Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2015 Mar 1;1(1):11-17.
doi: 10.1515/jccm-2015-0003. eCollection 2015 Jan.

The Value of the "Lab-Score" Method in Identifying Febrile Infants at Risk for Serious Bacterial Infections

Diana Aniela Moldovan  1   2 , Maria Despina Baghiu  1   3 , Alina Balas  2 , Sorana Teodora Truta  1   2
Affiliations

The Value of the "Lab-Score" Method in Identifying Febrile Infants at Risk for Serious Bacterial Infections

Diana Aniela Moldovan et al. J Crit Care Med (Targu Mures). .

Abstract

Introduction: Most children with fever without source will have a self limited viral infection though a small percent will develop a serious bacterial infection (SBI) like urinary tract infection, pneumonia, bacteraemia, meningitis or sepsis. The challenge facing practitioners is to distinguish between these two groups and currently biomarkers, like C-reactive protein (CRP) and Procalcitonin (PCT), are available for this purpose.The aim of the current study was to identify SBI in infants with fever without an identifiable cause using the recently introduced "Lab-score" combining C-reactive protein, procalcitonin and urine dipstick results.

Methods: This survey is part of an observational study aimed at identifying children with fever without source at risk of SBI. Patients were recruited from the Emergency Department of Tîrgu Mures Emergency Clinical County Hospital, Romania, during 2013. SBI diagnosis was based on urine, blood and cerebrospinal fluid cultures and chest radiographs. For infants, aged 7 days to 12 months, CRP and PCT were determined and the "Lab-score" was calculated. Positive and negative likelihood ratios and post test probabilities were calculated for each parameter and score.

Results: Of the ninety infants included in the study, SBI was diagnosed in nineteen (21.11%). Ten had a urinary tract infection, seven had pneumonia, one had a urinary tract infection and bacteraemia, and one had sepsis. Positive and negative likelihood ratios for CRP (≥40.0 mg/L) and PCT (≥0.5 ng/mL) were 10.27/0.45 and 7.07/0.24 and post-test probabilities 73%/65%. For a "Lab-score" (≥3), positive and negative likelihood ratios were 10.43/0.28, and the posttest probability was 73%.

Conclusions: In our survey the "Lab-score" proved a strong predictor for the identification of febrile infants at risk of SBI, but showed no significant difference compared with CRP and PCT which both proved equally good predictors for SBI.

Keywords: fever; infants; serious bacterial infections; “Lab-score”.

PubMed Disclaimer

Conflict of interest statement

Conflict of interest: None declared.

Figures

Figure 1
Figure 1
Positive and negative likelihood ratios and the post test probability for the “Lab-score” (≥3)
Figure 2
Figure 2
Positive and negative likelihood ratios and the post test probability for CRP (≥40 mg/L)
Figure 3
Figure 3
Positive and negative likelihood ratios and the post test probability for PCT (≥0.5 ng/mL)
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

References

    1. Baraff LJ.. Management of infants and young children with fever without source. Pediatr Ann. 2008;37:673–9. - PubMed
    1. Galetto Lacour A, Zamora SA, Gervaix A.. Bedside procalcitonin and C-reactive protein tests in children with fever without localizing signs of infection seen in a referralcenter. Paediatrics. 2003;112:1054–60. - PubMed
    1. Craig JC, Williams GJ, Jones M. et al. 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. 2010;340:c1594. doi: 10.1136/bmj.c1594. - DOI - PMC - PubMed
    1. Van den Bruel A, Haj-Hassan T, Thompson M, Buntinx F, Mant D.. Diagnostic value of clinical features at presentation to identify serious infection in children in developed countries: a systematic review. Lancet. 2010;375:834–45. - PubMed
    1. Van den Bruel A, Thompson MJ, Haj-Hassan T. et al. Diagnostic value of laboratory tests in identifying serious infections in febrile children: systematic review. BMJ. 2011;342:d3082. - PubMed

LinkOut - more resources