• Annick Galetto-Lacour, Samuel A Zamora, Barbara Andreola, Silvia Bressan, Laurence Lacroix, Liviana Da Dalt, and Alain Gervaix.
• Division of Pediatric Emergency Medicine, Geneva University Hospitals and University of Geneva, Geneva, Switzerland. annick.galetto@hcuge.ch
• Arch. Dis. Child. 2010 Dec 1; 95 (12): 968-73.

ObjectiveThe identification of severe bacterial infection (SBI)in children with fever without source (FWS) remains a diagnostic problem. The authors previously developed in their Swiss population a risk index score, called the Lab-score, associating three independent predictors of SBI, namely C reactive protein (CRP), procalcitonin (PCT) and urinary dipstick. The objective of this study was to validate the Lab-score in a population of children with FWS different from the derivation model.MethodsA prospective study, conducted in Padova, on 408 children aged 7 days to 36 months with FWS was recently published. PCT, CRP, white blood cell count (WBC) and urinary dipstick were determined in all children. The Lab-score was applied to this population and the diagnostic characteristics for the detection of SBI were calculated for the Lab-score and for any single variable used in the Italian study.ResultsFor the identification of SBI, the sensitivity of a score ≥3 was 86% (95% CI 77% to 92%) and the specificity 83% (95% CI 79% to 87%). The area under the receiver operating characteristic curve for the Lab-score (0.91) was significantly superior to that of any single variable: 0.71 for WBC, 0.86 for CRP and 0.84 for PCT. The Lab-score performed better than other laboratory markers, even when applied to children of different age groups (<3 months, 3-12 months and >12 months). The results obtained in this validation set population were comparable with those of the derivation set population.ConclusionsThis study validated the Lab-score as a valuable tool to identify SBI in children with FWS.

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