학술논문
External validation of a multivariable prediction model for identification of pneumonia and other serious bacterial infections in febrile immunocompromised children.
Document Type
Academic Journal
Author
Martin AJ; Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK.; Paediatric Immunology, Infectious Diseases and Allergy, Great North Children's Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK.; van der Velden FJS; Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK.; Paediatric Immunology, Infectious Diseases and Allergy, Great North Children's Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK.; von Both U; Department of Pediatrics, Division of Paediatric Infectious Diseases, Dr. von Hauner Children's Hospital, University Hospital, LMU Munich, Munich, Germany.; Tsolia MN; 2nd Department of Pediatrics, 'P. and A. Kyriakou' Chlidren's Hospital, National and Kapodistrian University of Athens, Athens, Greece.; Zenz W; Department of Pediatrics and Adolescent Medicine, Division of General Pediatrics, Medical University of Graz, Graz, Austria.; Sagmeister M; Department of Pediatrics and Adolescent Medicine, Division of General Pediatrics, Medical University of Graz, Graz, Austria.; Vermont C; Department of Paediatrics, Division of Infectious Diseases and Immunology, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands.; de Vries G; Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK.; Department of Paediatrics, Division of Infectious Diseases and Immunology, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands.; Kolberg L; Department of Pediatrics, Division of Paediatric Infectious Diseases, Dr. von Hauner Children's Hospital, University Hospital, LMU Munich, Munich, Germany.; Lim E; Paediatric Immunology, Infectious Diseases and Allergy, Great North Children's Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK.; Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK.; Pokorn M; Department of Infectious Diseases, University Medical Centre Ljubljana, Univerzitetni, Klinični, Ljubljana, Slovenia.; Department of Pediatrics, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia.; Zavadska D; Department of Pediatrics, Rīgas Universitāte, Children's Clinical University Hospital, Riga, Latvia.; Martinón-Torres F; Translational Pediatrics and Infectious Diseases, Pediatrics Department, Hospital Clínico Universitario de Santiago, Santiago de Compostela, Spain.; Rivero-Calle I; Translational Pediatrics and Infectious Diseases, Pediatrics Department, Hospital Clínico Universitario de Santiago, Santiago de Compostela, Spain.; Hagedoorn NN; Department of Paediatrics, Division of Infectious Diseases and Immunology, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands.; Usuf E; Disease Control and Elimination, Medical Research Council Unit The Gambia at the London School of Hygiene and Tropical Medicine, London, UK.; Schlapbach L; Neonatal and Pediatric Intensive Care Unit, Children's Research Center, University Children's Hospital Zürich, Zürich, Switzerland.; Kuijpers TW; Department of Pediatric Immunology, Rheumatology and Infectious Diseases, Amsterdam University Medical Center, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.; Pollard AJ; Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford, UK.; Yeung S; Clinical Research Department, Faculty of Infectious and Tropical Disease, London School of Hygiene and Tropical Medicine, London, UK.; Fink C; Micropathology Ltd, University of Warwick Science Park, Warwick, UK.; Voice M; Micropathology Ltd, University of Warwick Science Park, Warwick, UK.; Carrol E; Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, UK.; Agyeman PKA; Department of Pediatrics, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.; Khanijau A; Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, UK.; Alder Hey Children's NHS Foundation Trust, Liverpool, UK.; Paulus S; Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford, UK.; De T; Section of Paediatric Infectious Disease, Wright-Fleming Institute, Imperial College London, London, UK.; Herberg JA; Section of Paediatric Infectious Disease, Wright-Fleming Institute, Imperial College London, London, UK.; Levin M; Section of Paediatric Infectious Disease, Wright-Fleming Institute, Imperial College London, London, UK.; van der Flier M; Paediatric Infectious Diseases and Immunology, Amalia Children's Hospital, Radboud University Medical Center, Nijmegen, The Netherlands.; de Groot R; Paediatric Infectious Diseases and Immunology, Amalia Children's Hospital, Radboud University Medical Center, Nijmegen, The Netherlands.; Nijman R; Department of Paediatric Emergency Medicine, St. Mary's Hospital, Imperial College NHS Healthcare Trust, London, UK.; Faculty of Medicine, Department of Infectious Diseases, Section of Paediatric Infectious Diseases, Imperial College London, London, UK.; Emonts M; Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK marieke.emonts@newcastle.ac.uk.; Paediatric Immunology, Infectious Diseases and Allergy, Great North Children's Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK.; NIHR Newcastle Biomedical Research Centre, based at Newcastle upon Tyne Hospitals NHS Trust and Newcastle University, Newcastle upon Tyne, UK.
Source
Publisher: BMJ Pub. Group [etc.] Country of Publication: England NLM ID: 0372434 Publication Model: Electronic Cited Medium: Internet ISSN: 1468-2044 (Electronic) Linking ISSN: 00039888 NLM ISO Abbreviation: Arch Dis Child Subsets: MEDLINE
Subject
Language
English
Abstract
Objective: To externally validate and update the Feverkids tool clinical prediction model for differentiating bacterial pneumonia and other serious bacterial infections (SBIs) from non-SBI causes of fever in immunocompromised children.
Design: International, multicentre, prospective observational study embedded in PErsonalised Risk assessment in Febrile illness to Optimise Real-life Management across the European Union (PERFORM).
Setting: Fifteen teaching hospitals in nine European countries.
Participants: Febrile immunocompromised children aged 0-18 years.
Methods: The Feverkids clinical prediction model predicted the probability of bacterial pneumonia, other SBI or no SBI. Model discrimination, calibration and diagnostic performance at different risk thresholds were assessed. The model was then re-fitted and updated.
Results: Of 558 episodes, 21 had bacterial pneumonia, 104 other SBI and 433 no SBI. Discrimination was 0.83 (95% CI 0.71 to 0.90) for bacterial pneumonia, with moderate calibration and 0.67 (0.61 to 0.72) for other SBIs, with poor calibration. After model re-fitting, discrimination improved to 0.88 (0.79 to 0.96) and 0.71 (0.65 to 0.76) and calibration improved. Predicted risk <1% ruled out bacterial pneumonia with sensitivity 0.95 (0.86 to 1.00) and negative likelihood ratio (LR) 0.09 (0.00 to 0.32). Predicted risk >10% ruled in bacterial pneumonia with specificity 0.91 (0.88 to 0.94) and positive LR 6.51 (3.71 to 10.3). Predicted risk <10% ruled out other SBIs with sensitivity 0.92 (0.87 to 0.97) and negative LR 0.32 (0.13 to 0.57). Predicted risk >30% ruled in other SBIs with specificity 0.89 (0.86 to 0.92) and positive LR 2.86 (1.91 to 4.25).
Conclusion: Discrimination and calibration were good for bacterial pneumonia but poorer for other SBIs. The rule-out thresholds have the potential to reduce unnecessary investigations and antibiotics in this high-risk group.
Competing Interests: Competing interests: None declared.
(© Author(s) (or their employer(s)) 2024. No commercial re-use. See rights and permissions. Published by BMJ.)
Design: International, multicentre, prospective observational study embedded in PErsonalised Risk assessment in Febrile illness to Optimise Real-life Management across the European Union (PERFORM).
Setting: Fifteen teaching hospitals in nine European countries.
Participants: Febrile immunocompromised children aged 0-18 years.
Methods: The Feverkids clinical prediction model predicted the probability of bacterial pneumonia, other SBI or no SBI. Model discrimination, calibration and diagnostic performance at different risk thresholds were assessed. The model was then re-fitted and updated.
Results: Of 558 episodes, 21 had bacterial pneumonia, 104 other SBI and 433 no SBI. Discrimination was 0.83 (95% CI 0.71 to 0.90) for bacterial pneumonia, with moderate calibration and 0.67 (0.61 to 0.72) for other SBIs, with poor calibration. After model re-fitting, discrimination improved to 0.88 (0.79 to 0.96) and 0.71 (0.65 to 0.76) and calibration improved. Predicted risk <1% ruled out bacterial pneumonia with sensitivity 0.95 (0.86 to 1.00) and negative likelihood ratio (LR) 0.09 (0.00 to 0.32). Predicted risk >10% ruled in bacterial pneumonia with specificity 0.91 (0.88 to 0.94) and positive LR 6.51 (3.71 to 10.3). Predicted risk <10% ruled out other SBIs with sensitivity 0.92 (0.87 to 0.97) and negative LR 0.32 (0.13 to 0.57). Predicted risk >30% ruled in other SBIs with specificity 0.89 (0.86 to 0.92) and positive LR 2.86 (1.91 to 4.25).
Conclusion: Discrimination and calibration were good for bacterial pneumonia but poorer for other SBIs. The rule-out thresholds have the potential to reduce unnecessary investigations and antibiotics in this high-risk group.
Competing Interests: Competing interests: None declared.
(© Author(s) (or their employer(s)) 2024. No commercial re-use. See rights and permissions. Published by BMJ.)