Fever without source in infants aged 22-60 days: how laboratory tests perform at identifying bacterial infections and predicting the need for a lumbar puncture?

doi:10.5847/wjem.j.1920-8642.2025.004

World Journal of Emergency Medicine ›› 2025, Vol. 16 ›› Issue (1): 74-77.doi: 10.5847/wjem.j.1920-8642.2025.004

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Fever without source in infants aged 22-60 days: how laboratory tests perform at identifying bacterial infections and predicting the need for a lumbar puncture?

Keven Vachon¹^,², Geneviève Gravel¹^,²^,³, Samuel Leduc¹^,², Alexandra Larouche¹^,², Myriam Mallet¹, David Simonyan¹, Mahukpe Narcisse Ulrich Singbo¹, Julie Ouellet-Pelletier²^,³, Simon Berthelot¹^,²^,³()

¹Centre de Recherche du CHU de Québec-Université Laval, Population Health and Optimal Health Practices Axis, Québec G1V 4G2, Canada
²Faculty of Medicine, Université Laval, Québec G1V 0A6, Canada
³Centre Hospitalier de l’Université Laval (CHUL), Québec G1V 4G2, Canada

Received:2024-07-05 Accepted:2024-09-26 Online:2025-01-23 Published:2025-01-01
Contact: Simon Berthelot E-mail:simon.berthelot@fmed.ulaval.ca

Abstract

Keven Vachon, Geneviève Gravel, Samuel Leduc, Alexandra Larouche, Myriam Mallet, David Simonyan, Mahukpe Narcisse Ulrich Singbo, Julie Ouellet-Pelletier, Simon Berthelot. Fever without source in infants aged 22-60 days: how laboratory tests perform at identifying bacterial infections and predicting the need for a lumbar puncture?[J]. World Journal of Emergency Medicine, 2025, 16(1): 74-77.

Figures/Tables 2

Figure 1.

Table 1.

References 13

1	Burstein B, Anderson G, Yannopoulos A. Prevalence of serious bacterial infections among febrile infants 90 days or younger in a Canadian urban pediatric emergency department during the COVID-19 pandemic. JAMA Netw Open. 2021;4(7): e2116919.
2	Aronson PL, Thurm C, Alpern ER, Alessandrini EA, Williams DJ, Shah SS, et al. Variation in care of the febrile young infant ＜90 days in US pediatric emergency departments. Pediatrics. 2014; 134(4):667-77.
3	Dyer H. Evaluation and management of the febrile young infant (<90 days old) in the absence of universally accepted criteria for the risk of serious bacterial infection (SBI). Curr Probl Pediatr Adolesc Health Care. 2021; 51(4):100997.
4	Biondi EA, Byington CL. Evaluation and management of febrile, well-appearing young infants. Infect Dis Clin North Am. 2015; 29(3):575-85.
5	Gomez B, Mintegi S, Bressan S, Da Dalt L, Gervaix A, Lacroix L, et al. Validation of the “step-by-step” approach in the management of young febrile infants. Pediatrics. 2016; 138(2): e20154381.
6	Pantell RH, Roberts KB, Adams WG, Dreyer BP, Kuppermann N, O’Leary ST, et al. Evaluation and management of well-appearing febrile infants 8 to 60 days old. Pediatrics. 2021;148(2):e2021052228.
7	Goldstein B, Giroir B, Randolph A, International Consensus Conference on Pediatric Sepsis. International pediatric sepsis consensus conference: definitions for sepsis and organ dysfunction in pediatrics. Pediatr Crit Care Med.ed. 2005; 6(1):2-8.
8	Graaf S, Keuning MW, Pajkrt D, Plötz FB. Fever without a source in children: international comparison of guidelines. World J Pediatr. 2023; 19(2):120-8.
9	SAS Institute Inc. Sample 58775: estimating nonlinear combinations of model parameters. Available at: https://support.sas.com/kb/58/775.html
10	SAS Institute Inc. Sample 25018: plot ROC curve with cutpoint labeling and optimal cutpoint analysis. Available at: https://support.sas.com/kb/25/018.html
11	Yo CH, Hsieh PS, Lee SH, Wu JY, Chang SS, Tasi KC, et al. Comparison of the test characteristics of procalcitonin to C-reactive protein and leukocytosis for the detection of serious bacterial infections in children presenting with fever without source: a systematic review and meta-analysis. Ann Emerg Med. 2012; 60(5): 591-600.
12	Mahajan P, VanBuren JM, Tzimenatos L, Cruz AT, Vitale M, Powell EC, et al. Serious bacterial infections in young febrile infants with positive urinalysis results. Pediatrics. 2022; 150(4): e2021055633.
13	England JT, Del Vecchio MT, Aronoff SC. Use of serum procalcitonin in evaluation of febrile infants: a meta-analysis of 2317 patients. J Emerg Med. 2014; 47(6): 682-8.

Parameters		Sensitivity, % (95% CI)	Specificity, % (95% CI)	PPV, % (95% CI)	NPV, % (95% CI)	LR+ (95% CI)	LR- (95% CI)
Bacterial meningitis
	CRP ≥20 mg/L	50 (12-88)	84 (82-56)	1.4 (0.3-3.9)	99.7 (99.2-100.0)	3.1 (0.6-5.7)	0.6 (0.1-1.1)
	CRP ≥25 mg/L	50 (12-88)	87 (86-89)	1.7 (0.4-5.0)	99.8 (99.3-100.0)	4.0 (0.7-7.2)	0.6 (0.1-1.0)
	CRP ≥70 mg/L	33 (4-78)	97 (96-98)	4.4 (0.5-15.2)	99.7 (99.2-99.9)	10.5 (0-22.8)	0.7 (0.3-1.1)
	WBC <5×10⁹/L or ≥15×10⁹/L	71 (29-96)	75 (73-77)	1.2 (0.4-2.8)	99.8 (99.4-100)	2.9 (1.5-4.3)	0.4 (0-0.8)
Invasive bacterial infections
	CRP ≥20 mg/L	44 (24-65)	84 (82-86)	5.0 (2.5-8.8)	98.8 (98.0-99.3)	2.8 (1.5-4.1)	0.7 (0.4-0.9)
	CRP ≥25 mg/L	40 (21-61)	88 (86-89)	5.8 (2.8-10.3)	98.7 (97.9-99.3)	3.3 (1.6-4.9)	0.7 (0.5-0.9)
	CRP ≥70 mg/L	24 (9-45)	97 (96-98)	13.3 (5.1-26.8)	98.6 (97.8-99.1)	8.2 (1.9-14.5)	0.8 (0.6-1.0)
	WBC <5×10⁹/L or ≥15×10⁹/L	46 (27-67)	75 (73-77)	2.8 (1.5-4.9)	98.9 (98.2-99.4)	1.9 (1.1-2.6)	0.7 (0.5-1.0)
Serious bacterial infections
	CRP ≥20 mg/L	54 (47-60)	91 (89-93)	54.6 (47.7-61.3)	91.0 (89.2-92.6)	6.1 (4.8-7.5)	0.5 (0.4-0.6)
	CRP ≥25 mg/L	48 (41-54)	94 (92-95)	60.9 (53.3-68.2)	90.2 (88.3-91.8)	8.0 (5.8-10.1)	0.6 (0.5-0.6)
	CRP ≥70 mg/L	17 (13-23)	99 (99-100)	86.7 (73.2-95.0)	86.0 (84.0-87.9)	33.2 (5.0-61.4)	0.8 (0.8-0.9)
	WBC <5×10⁹/L or ≥15×10⁹/L	45 (39-52)	78 (76-81)	25.7 (21.6-30.1)	89.8 (88.0-91.4)	2.1 (1.7-2.5)	0.7 (0.6-0.8)

Fever without source in infants aged 22-60 days: how laboratory tests perform at identifying bacterial infections and predicting the need for a lumbar puncture?

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