Article Figures & Data
Figures
- FIGURE 1
Patient enrollment.
- FIGURE 2
Receiver operator curves for YOS and unstructured clinician suspicion to distinguish between febrile infants with and without any SBI (A) or invasive bacterial infections (B).
Tables
Normal Moderate Impairment Severe Impairment 1 point 3 points 5 points Quality of cry Strong with normal tone, or content and not crying Whimpering or sobbing Weak, moaning, or high-pitched Reaction to parents Cries briefly and then stops, or content and not crying Cries off and on Continual cry or hardly responds State variation If awake, stays awake, or if asleep and stimulated, wakes up quickly Eyes close briefly, awakes with prolonged stimulation Falls to sleep or will not rouse Color Pink Pale extremities or acrocyanosis Pale, cyanotic, mottled, or ashen Hydration Skin normal, eyes normal and mucous membranes moist Skin and eyes normal, and mouth slightly dry Skin doughy or tented and dry mucous membranes and/or sunken eyes Response (talk, smile) to social overtures Smiles or alert Brief smile or alert briefly No smile or face anxious, dull, expressionless, or no alerting N (% of the 444 Infants With Any SBI) Any SBI 444 (100) UTI 384 (86.5) With bacteremia 36 (8.1) With bacterial meningitis 3 (0.7) With bacteremia and bacterial meningitis 2 (0.5) Invasive SBI 97 (21.8) Bacteremia 84 (18.9) With bacterial meningitis 11 (2.5) Bacterial meningitis 24 (5.4) Infants could have >1 type of bacterial infection.
Any SBI, N = 444, n/N (%) Invasive Bacterial Infection, N = 97 n/N (%) No SBI, N = 4147, n/N (%) Age, da 32.0 (19.0–47.0) 25.0 (13.0–42.0) 38.0 (26.0–48.0) Boy 269/444 (60.6) 50/97 (51.5) 2326/4147 (56.1) Temperature, °Ca 38.6 (38.3–39.0) 38.6 (38.3–39.0) 38.3 (38.1–38.7) Peripheral WBC, cells/mm3a 13.5 (9.9–17.6) 10.7 (7.0–15.4) 9.6 (7.1–12.6) Peripheral ANC, cells/mm3a 6.9 (4.2–9.7) 5.4 (3.5–8.7) 3.1 (2.0–4.8) Urine obtained 429/444 (96.6) 91/97 (93.8) 3991/4147 (96.2) LP performed 399/444 (89.9) 92/97 (94.8) 3232/4147 (77.9) CSF WBC, cells/mm3a 5.0 (2.0–11.9) 5.4 (2.0–22.0) 3.0 (2.0–7.8) Positive CSF Gram-stain 9/399 (2.3) 8/92 (8.7) 9/3232 (0.3) Initial hospitalization 415/444 (93.5) 94/97 (96.9) 3037/4147 (73.2) ANC, absolute neutrophil count; CSF, cerebrospinal fluid.
↵a Median (IQR).
Clinician Suspicion for SBI, % Any SBI, N = 436, n (%) (95% CI) Invasive Bacterial Infection, N = 95, n (%) (95% CI) No SBI, N = 4104, n (%) (95% CI) <1 106 (6.4) (5.3–7.7) 16 (1.0) (0.6–1.6) 1542 (93.6) (92.3–94.7) 1–5 180 (9.3) (8.0–10.7) 37 (1.9) (1.3–2.6) 1760 (90.7) (89.3–92.0) 6–10 81 (12.2) (9.8–15.0) 22 (3.3) (2.1–5.0) 581 (87.8) (85.0–90.2) 11–50 55 (22.3) (17.2–28.0) 18 (7.3) (4.4–11.3) 192 (77.7) (72.0–82.8) >50 14 (32.6) (19.1–48.5) 2 (4.7) (0.6–15.8) 29 (67.4) (51.5–80.9) - TABLE 5
Test Characteristics of the YOS Score >6 and >10 as Well as Unstructured Clinician Suspicion ≥1% and ≥5% for the Identification of Infants With any SBI Overall Stratified by Patient Age (0–28 vs 29–60 d of Age)
Sensitivity, % (95% CI) Specificity, % (95% CI) Negative Predictive Value, % (95% CI) Likelihood Ratio +, % (95% CI) Likelihood Ratio, −, % (95% CI) YOS > 6 0.39 (0.35–0.44) 0.66 (0.64–0.67) 0.91 (0.90–0.92) 1.15 (1.01–1.30) 0.92 (0.85–1.00) 0–28 d 0.40 (0.33–0.48) 0.65 (0.62–0.68) 0.88 (0.85–0.90) 1.16 (0.96–1.40) 0.91 (0.81–1.03) 29–60 d 0.38 (0.32–0.45) 0.66 (0.64–0.68) 0.93 (0.91–0.94) 1.13 (0.96–1.33) 0.93 (0.84–1.03) YOS > 10 0.12 (0.09–0.15) 0.90 (0.89–0.91) 0.90 (0.89–0.91) 1.12 (0.85–1.47) 0.99 (0.95–1.02) 0–28 d 0.14 (0.09–0.20) 0.89 (0.87–0.91) 0.87 (0.85–0.89) 1.30 (0.89–1.91) 0.96 (0.91–1.02) 29–60 d 0.10 (0.06–0.14) 0.90 (0.89–0.91) 0.92 (0.91–0.93) 0.96 (0.64–1.42) 1.01 (0.96–1.05) Suspicion > 1% 0.76 (0.71–0.80) 0.38 (0.36–0.39) 0.94 (0.92–0.95) 1.21 (1.14–1.29) 0.65 (0.55–0.77) 0–28 d 0.74 (0.68–0.80) 0.33 (0.31–0.36) 0.90 (0.86–0.92) 1.11 (1.01–1.22) 0.77 (0.60–1.00) 29–60 d 0.77 (0.71–0.82) 0.40 (0.38–0.41) 0.95 (0.94–0.96) 1.27 (1.18–1.37) 0.59 (0.47–0.74) Suspicion > 5% 0.34 (0.30–0.39) 0.80 (0.79–0.82) 0.92 (0.91–0.93) 1.76 (1.52–2.03) 0.82 (0.76–0.87) 0–28 d 0.38 (0.31–0.45) 0.76 (0.74–0.79) 0.89 (0.87–0.91) 1.59 (1.29–1.96) 0.82 (0.73–0.92) 29–60 d 0.32 (0.26–0.38) 0.82 (0.81–0.84) 0.93 (0.92–0.94) 1.80 (1.47–2.20) 0.83 (0.76–0.90)
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The Yale Observation Scale Score and the Risk of Serious Bacterial Infections in Febrile Infants
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