Imperial College London
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DrJethroHerberg

Faculty of Medicine, Department of Infectious Disease

Clinical Reader in Paediatric Infectious Disease
 
 
 
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j.herberg

 
 
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Location

 

231Wright Fleming WingSt Mary's Campus

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Summary

 

Publications

Citation

BibTex format

@article{Hagedoorn:2021:10.1136/archdischild-2020-319794,
author = {Hagedoorn, N and Borensztajn, D and Nijman, R and Nieboer, D and Herberg, J and Balode, A and von, Both U and Carroll, E and Eleftheriou, I and Emonts, M and Van, Der Flier M and de, Groot R and Kohlmaier, B and Lim, E and Maconochie, I and Martinon-Torres, F and Pokorn, M and Strle, F and Tsolia, M and Zavadska, D and Zenz, W and Levin, M and Vermont, C and Moll, H},
doi = {10.1136/archdischild-2020-319794},
journal = {Archives of Disease in Childhood},
pages = {641--647},
title = {Development and validation of a prediction model for invasive bacterial infections in febrile children at European Emergency Departments: MOFICHE a prospective observational study},
url = {http://dx.doi.org/10.1136/archdischild-2020-319794},
volume = {106},
year = {2021}
}
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RIS format (EndNote, RefMan)

TY  - JOUR
AB  - Objectives To develop and cross-validate a multivariable clinical prediction model to identify invasive bacterial infections (IBI) and to identify patient groups who might benefit from new biomarkers.Design Prospective observational study.Setting 12 emergency departments (EDs) in 8 European countries.Patients Febrile children aged 0–18 years.Main outcome measures IBI, defined as bacteraemia, meningitis and bone/joint infection. We derived and cross-validated a model for IBI using variables from the Feverkidstool (clinical symptoms, C reactive protein), neurological signs, non-blanching rash and comorbidity. We assessed discrimination (area under the receiver operating curve) and diagnostic performance at different risk thresholds for IBI: sensitivity, specificity, negative and positive likelihood ratios (LRs).Results Of 16 268 patients, 135 (0.8%) had an IBI. The discriminative ability of the model was 0.84 (95% CI 0.81 to 0.88) and 0.78 (95% CI 0.74 to 0.82) in pooled cross-validations. The model performed well for the rule-out threshold of 0.1% (sensitivity 0.97 (95% CI 0.93 to 0.99), negative LR 0.1 (95% CI 0.0 to 0.2) and for the rule-in threshold of 2.0% (specificity 0.94 (95% CI 0.94 to 0.95), positive LR 8.4 (95% CI 6.9 to 10.0)). The intermediate thresholds of 0.1%–2.0% performed poorly (ranges: sensitivity 0.59–0.93, negative LR 0.14–0.57, specificity 0.52–0.88, positive LR 1.9–4.8) and comprised 9784 patients (60%).Conclusions The rule-out threshold of this model has potential to reduce antibiotic treatment while the rule-in threshold could be used to target treatment in febrile children at the ED. In more than half of patients at intermediate risk, sensitive biomarkers could improve identification of IBI and potentially reduce unnecessary antibiotic prescriptions.
AU  - Hagedoorn,N
AU  - Borensztajn,D
AU  - Nijman,R
AU  - Nieboer,D
AU  - Herberg,J
AU  - Balode,A
AU  - von,Both U
AU  - Carroll,E
AU  - Eleftheriou,I
AU  - Emonts,M
AU  - Van,Der Flier M
AU  - de,Groot R
AU  - Kohlmaier,B
AU  - Lim,E
AU  - Maconochie,I
AU  - Martinon-Torres,F
AU  - Pokorn,M
AU  - Strle,F
AU  - Tsolia,M
AU  - Zavadska,D
AU  - Zenz,W
AU  - Levin,M
AU  - Vermont,C
AU  - Moll,H
DO  - 10.1136/archdischild-2020-319794
EP  - 647
PY  - 2021///
SN  - 0003-9888
SP  - 641
TI  - Development and validation of a prediction model for invasive bacterial infections in febrile children at European Emergency Departments: MOFICHE a prospective observational study
T2  - Archives of Disease in Childhood
UR  - http://dx.doi.org/10.1136/archdischild-2020-319794
UR  - http://hdl.handle.net/10044/1/85093
VL  - 106
ER  -
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