This Article
Right arrow Full Text
Right arrow Full Text (PDF)
Right arrow P3Rs: Submit a response
Right arrow P3Rs: View responses
Right arrow Alert me when this article is cited
Right arrow Alert me when P3Rs are posted
Right arrow Alert me if a correction is posted
Right arrow Citation Map
Services
Right arrow E-mail this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in ISI Web of Science
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Add to My File Cabinet
Right arrow Download to citation manager
Right arrow reprints & permissions
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via CrossRef
Right arrow Citing Articles via ISI Web of Science (36)
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Galetto-Lacour, A.
Right arrow Articles by Gervaix, A.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Galetto-Lacour, A.
Right arrow Articles by Gervaix, A.
Related Collections
Right arrow Infectious Disease & Immunity
PEDIATRICS Vol. 112 No. 5 November 2003, pp. 1054-1060

Bedside Procalcitonin and C-Reactive Protein Tests in Children With Fever Without Localizing Signs of Infection Seen in a Referral Center

Annick Galetto-Lacour, MD, Samuel A. Zamora, MD and Alain Gervaix, MD

From the Department of Pediatrics, University Hospital of Geneva, Geneva, Switzerland

Objective. To assess the value of bedside tests for predicting the occurrence of severe bacterial infections (SBIs) in children with fever without source.

Methods. We conducted a prospective study of 99 children, aged 7 days to 36 months, who were seen for fever >38°C and no localizing sign of infection at the emergency department of the University Children’s Hospital of Geneva. Blood procalcitonin (PCT), C-reactive protein (CRP), and interleukin-6 (IL-6) values were determined using rapid tests and were compared with the total white blood cell (WBC) count with differential and clinical score. Specificity, sensitivity, predictive values, and multilevel likelihood ratios (LRs) with posttest probabilities of disease were calculated.

Results. Twenty-nine (29%) children received a diagnosis of having an SBI. PCT had the best sensitivity (93%) and negative predictive value (96%). Band count had the best specificity (93%), but its positive predictive value was only 38%. Multilevel LRs revealed that a PCT concentration <0.5 ng/mL (LR: 0.093) almost ruled out SBI (posttest probability of disease: 3.7%) in 54 (54%) subjects, whereas a value >2 ng/mL (LR: 5.2) increased the probability of SBI to 68% in 19 (19%) children. For CRP, values <40 mg/L (LR: 0.263) and >100 mg/L (LR: 14.483) generated posttest probabilities for SBI of 9.7% (61 subjects) and 86.5% (14 subjects), respectively. For WBC count, the posttest probabilities of SBI were modestly changed from the pretest prevalence.

Conclusions. PCT and CRP performed better than IL-6, WBC, and/or band count in predicting the occurrence of SBI. PCT and CRP bedside tests may be useful tools for emergency and private practice doctors and should be considered in the initial work-up of children with fever without source.

Key Words: interleukin-6 • procalcitonin • C-reactive protein • bacterial infection • fever without source • pediatrics • pyelonephritis

Abbreviations: ED, emergency department • SBI, serious bacterial infection • FWS, fever without source • WBC, white blood cell • PCT, procalcitonin • CRP, C-reactive protein • IL-6, interleukin 6 • EDTA, ethylenediaminetetraacetic acid • DMSA, 99M-dimercaptosuccinic acid • CSF, cerebrospinal fluid • LR, likelihood ratio • UTI, urinary tract infection

Received for publication Mar 17, 2003; Accepted Jul 9, 2003.




This article has been cited by other articles:


Home page
 Eur Respir JHome page
M. Christ-Crain and B. Muller
Biomarkers in respiratory tract infections: diagnostic guides to antibiotic prescription, prognostic markers and mediators
Eur. Respir. J., September 1, 2007; 30(3): 556 - 573.
[Abstract] [Full Text] [PDF]

Home page
 Arch. Dis. Child. Fetal Neonatal Ed.Home page
P Rudd
Is there a place for "drive thru" management of neonatal fever? Not yet!
Arch. Dis. Child. Fetal Neonatal Ed., January 1, 2007; 92(1): F2 - F3.
[Full Text] [PDF]

Home page
 Arch. Dis. Child.Home page
N. Maheshwari
How useful is C-reactive protein in detecting occult bacterial infection in young children with fever without apparent focus?
Arch. Dis. Child., June 1, 2006; 91(6): 533 - 535.
[Full Text] [PDF]

Home page
 PediatricsHome page
A. L. Hsiao, L. Chen, and M. D. Baker
Incidence and Predictors of Serious Bacterial Infections Among 57- to 180-Day-Old Infants
Pediatrics, May 1, 2006; 117(5): 1695 - 1701.
[Abstract] [Full Text] [PDF]

Home page
 PediatricsHome page
G. L. Jackson, W. D. Engle, D. M. Sendelbach, D. A. Vedro, S. Josey, J. Vinson, C. Bryant, G. Hahn, and C. R. Rosenfeld
Are Complete Blood Cell Counts Useful in the Evaluation of Asymptomatic Neonates Exposed to Suspected Chorioamnionitis?
Pediatrics, May 1, 2004; 113(5): 1173 - 1180.
[Abstract] [Full Text] [PDF]

P3Rs:

Read all P3Rs

Procalcitonin Study: Methadological errors
Sudhin Thayyil
Pediatrics Online, 22 Jan 2004 [Full text]
Re: Procalcitonin Study: Methadological errors
Alain GERVAIX, et al.
Pediatrics Online, 25 Feb 2004 [Full text]