BibTex format
@article{Martin:2023:10.1136/archdischild-2023-325869,
author = {Martin, AJ and van, der Velden FJS and von, Both U and Tsolia, MN and Zenz, W and Sagmeister, M and Vermont, C and de, Vries G and Kolberg, L and Lim, E and Pokorn, M and Zavadska, D and Martinón-Torres, F and Rivero-Calle, I and Hagedoorn, NN and Usuf, E and Schlapbach, L and Kuijpers, TW and Pollard, AJ and Yeung, S and Fink, C and Voice, M and Carrol, E and Agyeman, PKA and Khanijau, A and Paulus, S and De, T and Herberg, JA and Levin, M and van, der Flier M and de, Groot R and Nijman, R and Emonts, M},
doi = {10.1136/archdischild-2023-325869},
journal = {Archives of Disease in Childhood},
pages = {59--66},
title = {External validation of a multivariable prediction model for identification of pneumonia and other serious bacterial infections in febrile immunocompromised children},
url = {http://dx.doi.org/10.1136/archdischild-2023-325869},
volume = {109},
year = {2023}
}
RIS format (EndNote, RefMan)
TY - JOUR
AB - 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.
AU - Martin,AJ
AU - van,der Velden FJS
AU - von,Both U
AU - Tsolia,MN
AU - Zenz,W
AU - Sagmeister,M
AU - Vermont,C
AU - de,Vries G
AU - Kolberg,L
AU - Lim,E
AU - Pokorn,M
AU - Zavadska,D
AU - Martinón-Torres,F
AU - Rivero-Calle,I
AU - Hagedoorn,NN
AU - Usuf,E
AU - Schlapbach,L
AU - Kuijpers,TW
AU - Pollard,AJ
AU - Yeung,S
AU - Fink,C
AU - Voice,M
AU - Carrol,E
AU - Agyeman,PKA
AU - Khanijau,A
AU - Paulus,S
AU - De,T
AU - Herberg,JA
AU - Levin,M
AU - van,der Flier M
AU - de,Groot R
AU - Nijman,R
AU - Emonts,M
DO - 10.1136/archdischild-2023-325869
EP - 66
PY - 2023///
SN - 0003-9888
SP - 59
TI - External validation of a multivariable prediction model for identification of pneumonia and other serious bacterial infections in febrile immunocompromised children
T2 - Archives of Disease in Childhood
UR - http://dx.doi.org/10.1136/archdischild-2023-325869
VL - 109
ER -