J Korean Soc Emerg Med.  2019 Jun;30(3):281-288. 10.0000/jksem.2019.30.3.281.

Clinical characteristics of febrile young infants with serious bacterial infection in the emergency departments in Korea and validation of Philadelphia criteria and modified Philadelphia criteria: retrospective multicenter study

Affiliations
  • 1Department of Emergency Medicine, Soonchunhyang University College of Medicine, Cheonan, Korea. 43210@schmc.ac.kr
  • 2Department of Pediatrics, Soonchunhyang Unversity College of Medicine, Cheonan, Korea.

Abstract


OBJECTIVE
This study examined the characteristics of febrile young infants with a serious bacterial infection (SBI) who visited emergency centers in Korea and validated the Philadelphia criteria and modified Philadelphia criteria to predict the risk of SBI.
METHODS
This was a retrospective study conducted on 450 infants aged 31 days to 56 days who visited three emergency centers with fever from September 2014 to August 2017. The characteristics of the SBI patients were analyzed, and the validation of the Philadelphia and modified Philadelphia criteria sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy were checked.
RESULTS
Of 450 patients, 165 patients (36.7%) had SBI, such as urinary tract infection (33.3%), bacteremia (4.0%), acute osteomyelitis (0.2%), and bacterial meningitis (BM) in two patients (0.4%). The most common pathogen of invasive bacterial infection was Escherichia coli. In the Philadelphia criteria, the sensitivity, specificity, PPV, NPV, and accuracy were 73.9%, 47.0%, 44.7%, 75.7%, and 56.9%, respectively. In the modified Philadelphia criteria that excluded lumbar puncture as a predictor, the sensitivity, specificity, PPV, NPV, and accuracy were 93.3%, 31.9%, 44.3%, 89.2%, and 54.4%, respectively. The most common failed low risk criteria was appearance (43.3%). Two patients with bacterial meningitis were excluded from low risk group by the modified Philadelphia criteria. Although one out of 2 patients met the failed low risk criteria due to their poor condition, this factor is not objective, so BM can be missed.
CONCLUSION
Bacterial meningitis was too rare in this study. New criteria are needed to predict SBI. The Philadelphia and modified Philadelphia criteria were not useful for predicting SBI in this study. Other prediction models will be needed to predict SBI in the vaccination era.

Keyword

Fever; Infant; Bacterial; Meningitis; Lumbar puncture

MeSH Terms

Bacteremia
Bacterial Infections*
Emergencies*
Emergency Service, Hospital*
Escherichia coli
Fever
Fibrinogen
Humans
Infant*
Korea*
Meningitis
Meningitis, Bacterial
Osteomyelitis
Retrospective Studies*
Sensitivity and Specificity
Spinal Puncture
Urinary Tract Infections
Vaccination
Fibrinogen
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