The Yale Observation Scale Score and the Risk of Serious Bacterial Infections in Febrile Infants

To assess the performance of the Yale Observation Scale (YOS) score and unstructured clinician suspicion to identify febrile infants ≤60 days of age with and without serious bacterial infections (SBIs). We performed a planned secondary analysis of a prospective cohort of non-critically ill, febrile,...

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Bibliographic Details
Published in:Pediatrics (Evanston) 2017-07, Vol.140 (1)
Main Authors: Nigrovic, Lise E, Mahajan, Prashant V, Blumberg, Stephen M, Browne, Lorin R, Linakis, James G, Ruddy, Richard M, Bennett, Jonathan E, Rogers, Alexander J, Tzimenatos, Leah, Powell, Elizabeth C, Alpern, Elizabeth R, Casper, T Charles, Ramilo, Octavio, Kuppermann, Nathan
Format: Article
Language:English
Subjects:
Bacterial infections
Bacterial Infections - complications
Bacterial Infections - diagnosis
Cross-Sectional Studies
Female
Fever - etiology
Health aspects
Humans
Infant
Infant, Newborn
Infants
Male
Prospective Studies
Risk Assessment
Risk factors
Severity of Illness Index
Urinary tract infections
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Summary:To assess the performance of the Yale Observation Scale (YOS) score and unstructured clinician suspicion to identify febrile infants ≤60 days of age with and without serious bacterial infections (SBIs). We performed a planned secondary analysis of a prospective cohort of non-critically ill, febrile, full-term infants ≤60 days of age presenting to 1 of 26 participating emergency departments in the Pediatric Emergency Care Applied Research Network. We defined SBIs as urinary tract infections, bacteremia, or bacterial meningitis, with the latter 2 considered invasive bacterial infections. Emergency department clinicians applied the YOS (range: 6-30; normal score: ≤10) and estimated the risk of SBI using unstructured clinician suspicion (50%). Of the 4591 eligible infants, 444 (9.7%) had SBIs and 97 (2.1%) had invasive bacterial infections. Of the 4058 infants with YOS scores of ≤10, 388 (9.6%) had SBIs (sensitivity: 51/439 [11.6%]; 95% confidence interval [CI]: 8.8%-15.0%; negative predictive value: 3670/4058 [90.4%]; 95% CI: 89.5%-91.3%) and 72 (1.8%) had invasive bacterial infections (sensitivity 23/95 [24.2%], 95% CI: 16.0%-34.1%; negative predictive value: 3983/4055 [98.2%], 95% CI: 97.8%-98.6%). Of the infants with clinician suspicion of
ISSN:0031-4005
1098-4275
DOI:10.1542/peds.2017-0695