단일기관 응급실에서 시행한 90일 미만 발열 환자에 대한 Step-by-Step approach의 후향적 타당도평가
Retrospective validation of the Step-by-Step approach for febrile infants younger than 90 days in the emergency department
박재상, 김중헌, 김원영,
소속 상세정보
박재상 ( Park Jae-Sang )
울산대학교 의과대학 응급의학교실
김중헌 ( Kim Jung-Heon )
울산대학교 의과대학 응급의학교실
김원영 ( Kim Won-Young )
울산대학교 의과대학 응급의학교실
Abstract
Purpose: To retrospectively validate the Step-by-Step approach, a sequential algorithm for prediction of serious bacterial infections (SBI) using the appearance, age, and inflammatory markers, in febrile infants younger than 90 days.
Methods: The presence of SBI was reviewed in febrile infants younger than 90 days undergoing blood and urine cultures (using perineal adhesive bags), assays for procalcitonin, C-reactive protein and absolute neutrophil count, and urinalysis at the emergency department from September 2015 through August 2017. The low-risk infants were classified according to the Step-by-Step approach. SBI was defined as urinary tract infection (UTI), bacteremia or meningitis. We measured the sensitivity and negative predictive value (NPV) of the approach in predicting SBI, and compared the values to those of the Rochester criteria and the Lab-score.
Results: Of 488 febrile infants (44.7% underwent lumbar puncture), 71 (14.5%) had SBI, including 67 UTI, 5 bacteremia, and 3 meningitis (mutually inclusive). Of 208 low-risk infants (42.6%), no SBI was found. The Step-by-Step approach showed a 100% sensitivity (95% confidence interval [CI]: 94.9-100.0) and NPV (95% CI: not applicable). The Rochester criteria showed a 98.6% sensitivity (95% CI: 92.4-100.0) and 99.6% NPV (95% CI: 97.1-99.9), and missed 1 meningitis. The Lab-score showed a 59.2% sensitivity (95% CI: 46.8-70.7) and 93.2% NPV (95% CI: 91.2-94.8), and missed 2 meningitis and 27 UTI.
Conclusion: The Step-by-Step approach showed a 100% sensitivity and NPV in predicting SBI. This approach may help predict SBI without lumbar puncture in febrile infants younger than 90 days.
키워드
Bacterial Infections; Biochemical Marker; Emergency Service; Hospital; Infant; Risk Assessment; Spinal Puncture
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