• S E Bleeker, G Derksen-Lubsen, D E Grobbee, A R T Donders, K G M Moons, and H A Moll.
• Erasmus Medical Center - Sophia, Department of Paediatrics, Rotterdam, The Netherlands.
• Acta Paediatr. 2007 Jan 1; 96 (1): 100-4.

AimTo externally validate and update a previously developed rule for predicting the presence of serious bacterial infections in children with fever without apparent source.MethodsPatients, 1-36 mo, presenting with fever without source, were prospectively enrolled. Serious bacterial infection included bacterial meningitis, sepsis, bacteraemia, pneumonia, urinary tract infection, bacterial gastroenteritis, osteomyelitis/ethmoiditis. The generalizability of the original rule was determined. Subsequently, the prediction rule was updated using all available data of the patients with fever without source (1996-1998 and 2000-2001, n = 381) using multivariable logistic regression.Resultsthe generalizability of the rule appeared insufficient in the new patients (n = 150). In the updated rule, independent predictors from history and examination were duration of fever, vomiting, ill clinical appearance, chest-wall retractions and poor peripheral circulation (ROC area (95%CI): 0.69 (0.63-0.75)). Additional independent predictors from laboratory were serum white blood cell count and C-reactive protein, and in urinalysis > or = 70 white bloods (ROC area (95%CI): 0.83 (0.78-0.88).ConclusionsA previously developed prediction rule for predicting the presence of serious bacterial infection in children with fever without apparent source was updated. Its clinical score can be used as a first screening tool. Additional laboratory testing may specify the individual risk estimate (range: 4-54%) further.

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