Accuracy of the “Traffic Light” Clinical Decision Rule for Serious Bacterial Infections in Young Children with Fever: A Retrospective Cohort Study

Computed tomography (CT) scans are useful for confirming head injury diagnoses. However, there is no standard clinical decision rule (CDR) for determining the need for CT scanning in pediatric patients with head injuries. We developed a CDR and conducted a retrospective cohort study to evaluate its diagnostic accuracy in identifying children with clinically important traumatic brain injury (ciTBI). We selected predictors based on three existing CDRs: CATCH, CHALICE, and PECARN. Of the 2569 eligible patients, 645 (439 (68%) boys, median age: five years) were included in this study. In total, 59 (9%) patients showed ciTBI, and 129 (20%) were admitted to hospital. The novel CDR comprised six predictors of abnormal CT findings. It had a sensitivity of 79.5% (95% confidence interval (CI): 65.5–89.0%) and a specificity of 50.9% (95% CI: 48.9–52.3%). The area under the receiver-operating characteristic curve (0.72, 95% CI: 0.67–0.77) was non-inferior to those of CATCH, CHALICE, and PECARN (0.71, 95% CI: 0.66–0.77; 0.67, 95% CI: 0.61–0.74; and 0.69, 95% CI: 0.64–0.73, respectively; p = 0.57). The novel CDR was statistically noninferior in diagnostic accuracy compared to the three existing CDRs. Further development and validation studies are needed before clinical application.

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43 The Prevalence of Serious Bacterial Infections in Infants less than 90 Days with and without Features of a Viral Infection: A Retrospective Cohort Study

Paediatrics & Child Health ◽

10.1093/pch/pxab061.034 ◽

2021 ◽

Vol 26 (Supplement_1) ◽

pp. e32-e32

Author(s):

Osama Algrigri ◽

Asma Mirza ◽

Eman Rezk ◽

Jeffrey Pernica ◽

Mohamed Eltorki

Keyword(s):

Risk Factors ◽

Cohort Study ◽

Viral Infection ◽

Clinical Features ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

Bacterial Infections ◽

Subject Area ◽

Future Research ◽

Serious Bacterial Infections

Abstract Primary Subject area Emergency Medicine - Paediatric Background Prior studies suggest the prevalence of serious bacterial infections (SBI) (i.e., urinary tract infection [UTI], bacteremia, or meningitis) is lower in infants with a viral infection compared to those with fever without a source (FWS) (2-3% vs. 10-15%). Objectives To determine the difference in proportion of SBI in infants with and without clinical features of a viral infection. Design/Methods A retrospective cohort study was done on a consecutive sample of infants ≤ 90 days seen at a pediatric ED over a 5-year period ending August 30, 2019. Eligible subjects had rectal temperatures ≥ 38°C, and had ≥ 1 screening test for SBI (urine, blood and/or cerebrospinal fluid cultures). Excluded were infants who received antibiotics in the past 7 days, had congenital anomalies, required intensive care, or were preterm. We defined a clinical viral infection as > 1 clinical features of a respiratory viral infection (new-onset sneezing, cough, rhinorrhea, or shortness of breath). UTI was defined as per American Academy of Pediatrics guidelines. Results We screened 7021 charts and 885 (12%) were eligible. Of these, 498 (56%) had a clinical viral infection and 387 (44%) did not. Blood and urine cultures were collected from 860 (97%) infants and 308 (35%) had a lumbar puncture. Overall, 84 (10%) infants had an SBI: 76 (9%) UTI, 6 (0.7%) isolated bacteremia, and 2 (0.2%) meningitis. Among those with clinical viral infection, 23 (5%) had SBI, compared to 61 (16%) without viral infection (risk difference [RD] 11%, 95% CI [7%, 15%]). Both cases of meningitis occurred in infants ≤28 days and without any viral symptoms. A logistic regression was done to ascertain the effects of clinical viral infection, known risk factors for sepsis, age ≤ 28 days, or a temperature ≥ 39°C on the likelihood of SBI. Of the 4 predictors, only clinical viral infection and the presence of known risk factors for sepsis were significantly associated with SBI (odds ratio [OR] 0.3, 95% CI [0.17, 0.48] and 2.5, 95% CI [1.4, 4.5], respectively). Proportions of contaminated blood culture and urine culture were 5% (95% CI [4%, 7%]) and 14% (95% CI [12%, 17%]), respectively. Conclusion SBI prevalence in infants without features of a viral infection on assessment is triple that of infants with viral symptoms. Contaminant blood and urine cultures are folds higher than true pathological cultures. Future research is needed to identify infants at low risk of SBI without invasive testing.

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Development of a Clinical Decision Rule for the Early Safe Discharge of Patients with Mild Traumatic Brain Injury and Findings on Computed Tomography Brain Scan: A Retrospective Cohort Study

Journal of Neurotrauma ◽

10.1089/neu.2019.6652 ◽

2020 ◽

Vol 37 (2) ◽

pp. 324-333 ◽

Cited By ~ 2

Author(s):

Carl Marincowitz ◽

Fiona E. Lecky ◽

Victoria Allgar ◽

Peter Hutchinson ◽

Hadir Elbeltagi ◽

...

Keyword(s):

Computed Tomography ◽

Traumatic Brain Injury ◽

Cohort Study ◽

Brain Injury ◽

Mild Traumatic Brain Injury ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

Clinical Decision ◽

Clinical Decision Rule ◽

Brain Scan

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Incidence of Kawasaki disease before and during the COVID-19 pandemic: a retrospective cohort study in Japan

BMJ Paediatrics Open ◽

10.1136/bmjpo-2021-001034 ◽

2021 ◽

Vol 5 (1) ◽

pp. e001034

Author(s):

Kyohei Iio ◽

Kousaku Matsubara ◽

Chisato Miyakoshi ◽

Kunitaka Ota ◽

Rika Yamaoka ◽

...

Keyword(s):

Cohort Study ◽

Kawasaki Disease ◽

Infectious Diseases ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

Bacterial Infections ◽

Epidemiological Studies ◽

Primary Objective ◽

Temporal Association ◽

Difference In Difference

BackgroundEpidemiological studies in Kawasaki disease (KD) have suggested infectious aetiology. During the COVID-19 pandemic, measures for mitigating SARS-CoV-2 transmission also suppress the circulation of other contagious microorganisms. The primary objective is to compare the number and incidence of KD before and during the COVID-19 pandemic in Japan, and the secondary objective is to investigate temporal association between the KD epidemiology and activities of SARS-CoV-2 and other viral and bacterial infections.MethodsA retrospective cohort study was conducted between 2016 and 2020 in Kobe, Japan. We collected information of hospitalised KD children in Kobe. Child population was identified through the resident registry system. Activity of COVID-19 and 11 other infectious diseases was derived from a public health monitoring system. Monthly change of KD incidence was analysed using a difference-in-difference regression model.ResultsThroughout the study period, 1027 KD children were identified. KD had begun to decline in April 2020, coinciding with the beginning of the COVID-19 pandemic. The number of KD cases (n=66) between April and December 2020 was 40% of the average in the same period in 2016–2019 (165/year). Annual KD incidence was 315, 300, 353, 347 and 188/100 000 children aged 0–4 years in 2016–2020, respectively. The difference-in-difference value of KD incidence was significantly reduced in the fourth quarter in 2020 (−15.8, 95% CI −28.0 to −3.5), compared with that in 2016–2019. Sentinel surveillance showed a marked decrease of all infectious diseases except exanthema subitum after the beginning of the COVID-19 pandemic. There were 86 COVID-19 cases aged <10 years and no KD children associated with COVID-19.ConclusionThis study showed that the number and incidence of KD was dramatically reduced during the COVID-19 pandemic in Japan. This change was temporally associated with decreased activities of various infectious diseases other than COVID-19, supporting the hypothesis of infection-triggered pathogenesis in KD.

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Catheter to vein ratio and risk of peripherally inserted central catheter (PICC)-associated thrombosis according to diagnostic group: a retrospective cohort study

BMJ Open ◽

10.1136/bmjopen-2020-045895 ◽

2021 ◽

Vol 11 (7) ◽

pp. e045895

Author(s):

Rebecca Sharp ◽

Peter Carr ◽

Jessie Childs ◽

Andrew Scullion ◽

Mark Young ◽

...

Keyword(s):

Cohort Study ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

Clinical Decision Making ◽

Clinical Decision ◽

Primary Outcome Measure ◽

Diagnostic Group ◽

Peripherally Inserted Central Catheter ◽

Central Catheter ◽

Characteristic Analysis

ObjectivesDetermine the effect of the catheter to vein ratio (CVR) on rates of symptomatic thrombosis in individuals with a peripherally inserted central catheter (PICC) and identify the optimal CVR cut-off point according to diagnostic group.DesignRetrospective cohort study.Setting4 tertiary hospitals in Australia and New Zealand.ParticipantsAdults who had undergone PICC insertion.Primary outcome measureSymptomatic thrombus of the limb in which the PICC was inserted.Results2438 PICC insertions were included with 39 cases of thrombosis (1.6%; 95% CI 1.14% to 2.19%). Receiver operator characteristic analysis was unable to be performed to determine the optimal CVR overall or according to diagnosis. The association between risk of thrombosis and CVR cut-offs commonly used in clinical practice were analysed. A 45% cut-off (≤45% versus ≥46%) was predictive of thrombosis, with those with a higher ratio having more than twice the risk (relative risk 2.30; 95% CI 1.202 to 4.383; p=0.01). This pattern continued when only those with malignancy were included in the analysis, those with cancer had twice the risk of thrombosis with a CVR greater than 45%. Whereas the 33% CVR cut-off was not associated with statistically significant results overall or in those with malignancy. Neither the 33% or 45% CVR cut-off produced statistically significant results in those with infection or other non-malignant conditions.ConclusionsAdherence to CVR cut-offs are an important component of PICC insertion clinical decision making to reduce the risk of thrombosis. These results suggest that in individuals with cancer, the use of a CVR ≤45% should be considered to minimise risk of thrombosis. Further research is needed to determine the risk of thrombosis according to malignancy type and the optimal CVR for those with a non-malignant diagnosis.

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