scholarly journals Yale observation scale for bacterial infection in febrile children

2020 ◽  
Vol 7 (2) ◽  
pp. 424
Author(s):  
Shiwani Mangla ◽  
Hemant Jain
Keyword(s):  
Blood Culture ◽  
Bacterial Infection ◽  
Roc Curve ◽  
Early Recognition ◽  
Predictive Ability ◽  
Cost Effective ◽  
P Value ◽  
Observation Scale ◽  
Causes Of Mortality ◽  
Yale Observation Scale

Background: Sepsis is one of the leading causes of mortality in children under 5 years by UNICEF statistics which is difficult to diagnose because of nonspecific initial clinical presentation and potential for rapid deterioration. In this regard use of Yale Observation Scale assists in early recognition of serious bacterial infection than other laboratory investigation as it is simple, quick, easy to apply and cost-effective bed side scale.Methods: All eligible young febrile infants and children were consecutively enrolled in the study. Axillary temperatures of the cases were documented. Yale observation scoring was done. Blood sample were sent for culture and sensitivity. Colonies were identified morphologically by Gram stain and biochemically. The collected data was analyzed using ROC curve for finding cut off scores of Yale Observation Scale for prediction of severe bacterial illness and final outcome. Statistical analysis was performed using the Statistical Packages for Social Sciences (SPSS) version 14 for MS Window.Results: Bacteremia was found in 23(15.3%) out of total 150 young febrile children enrolled in the present study. It shows that in lower YOS score blood culture was sterile and in higher YOS score blood culture was positive for bacteremia, which is statistically significant with p value (<0.05). As per ROC curve analyses the best cut off value of YOS for prediction of bacteremia was 17.5 with sensitivity 91.3%, specificity 81.9%, PPV 47.7% and NPV of 98.1%.Conclusions: YOS of  >17.5 has a good predictive ability for prediction of bacteraemia in young febrile children.

scholarly journals Diagnostic accuracy of Yale observational scale in bacteremia in infants and children.

2020 ◽  
Vol 27 (07) ◽  
pp. 1346-1352
Author(s):  
Motia Javed ◽  
Mehboob Alam Siddiqui ◽  
Zahid Mahmood Anjum ◽  
Fazal Elahi Bajwa ◽  
Hina Ayesha
Keyword(s):  
Blood Culture ◽  
Diagnostic Accuracy ◽  
Rural Areas ◽  
Viral Infections ◽  
Signs And Symptoms ◽  
Early Screening ◽  
Cross Sectional ◽  
Observation Scale ◽  
Viable Bacteria ◽  
Yale Observation Scale

Bacteremia is the presence of viable bacteria in the circulating blood. Bacteremia is diagnosed by blood culture. Yale Observation Scale (YOS) is a scale consisting of six observational items originally and is validated in young febrile children to detect serious illness. If YOS found to be highly accurate, it will help us to design a protocol for early screening and diagnosis of bacteremia in infants so that patient’s morbidity and mortality can be minimized by early treatment. Objectives: To determine the diagnostic accuracy of Yale Observation Scale (YOS) for diagnosing bacteremia, taking blood culture as gold standard. Study Design: Cross-Sectional Validation study. Setting: Department of Pediatrics, D.H.Q Hospital, Faisalabad. Period: 26th May, 2016 to 25th November, 2016. Material & Methods: One hundred and five patients suffering from fever>38 0C, having age from 3-36 months were included in the study. Patients already taking antibiotics, immune compromised, patients with signs and symptoms of malaria or viral infections were excluded. YOS was calculated and blood culture was performed in all patients to diagnose bacteremia. Results: Out of 105 patients, mean age was 12.9±8.24 months. There were 55(52.4%) male and 50(47.6%) female patients. Sensitivity of YOS in diagnosing bacteremia was 90.63%, specificity 79.45%, PPV 65.91%, NPV 95.08% and diagnostic accuracy was 82.86%. Conclusion: YOS can be used as a key diagnostic tool in detecting bacteremia. So, by using this tool many cases in the rural areas can be diagnosed and managed early.

scholarly journals IN-HOSPITAL MORTALITY AND THE PREDICTIVE ABILITY OF THE MODIFIED EARLY WARNING SCORE IN GHANA

2020 ◽  
Author(s):  
Enoch J Abbey ◽  
Jennifer S. Mammen ◽  
Samara E. Soghoian ◽  
Maureen Cadorette ◽  
Promise Ariyo
Keyword(s):  
Early Warning ◽  
Roc Curve ◽  
Predictive Accuracy ◽  
Early Recognition ◽  
Vital Signs ◽  
Objective Measure ◽  
Predictive Ability ◽  
Clinical Deterioration ◽  
Early Warning Score ◽  
African Countries

ABSTRACT BACKGROUND The modified early warning score (MEWS) is an objective measure of illness severity that promotes early recognition of clinical deterioration in critically ill patients. Its primary use is to; facilitate faster intervention or increase the level of care. Despite, its adoption in some African countries, MEWS is not standard of care in Ghana. We assessed the validity of MEWS as a predictor of mortality, among medically ill inpatients at the Korle Bu Teaching Hospital (KBTH), Accra, Ghana. We sought to identify the predictive ability of MEWS in detecting clinical deterioration among medical in-patients and its comparability to the routinely measured vital signs. METHOD This was a retrospective study of medical inpatients, aged >=13 years and admitted at KBTH from January 2017 to March 2019. Vital signs at 48 hours after admission were coded using MEWS criteria, to obtain a limited MEWS score (LMEWS) and the level of consciousness imputed to obtain a full MEWS score (MEWS). A predictive model comparing mortality among patients with significant MEWS (L/MEWS >=4) and non-significant MEWS (L/MEWS <4) scores was designed using multiple logistic regression. Internally validated for predictive accuracy, using the Receiver Operating Characteristic (ROC) curve. RESULTS 112 patients were included in the study. The adjusted odds of death comparing patients with a significant MEWS to patients with non-significant MEWS was 6.33(95% CI 1.96 to 20.48). Similarly, the adjusted odds of death comparing patients with significant versus non-significant LMEWS was 8.22(95% CI 2.45 to 27.56). The ROC curve for each analysis had a C static of 0.83 and 0.84 respectively. CONCLUSION LMEWS is a good predictor of mortality and comparable to MEWS. Adoption of LMEWS can identify medical in-patients at risk of deterioration and death.

scholarly journals Procalcitonin as a biomarker of bacterial infection in critically ill patients admitted with suspected Sepsis in Intensive Care Unit of a tertiary care hospital

2021 ◽  
Vol 37 (7) ◽  
Author(s):  
Afshan Bibi ◽  
Nida Basharat ◽  
Muhammad Aamir ◽  
Zujaja Hina Haroon
Keyword(s):  
Intensive Care ◽  
Blood Culture ◽  
Bacterial Infection ◽  
Critically Ill ◽  
Positive Blood Culture ◽  
Critically Ill Patients ◽  
Tertiary Care ◽  
P Value ◽  
Care Hospital ◽  
Significant Difference

Objective: To compare the diagnostic accuracy of procalcitonin (PCT), C- reactive protein (CRP), total leukocyte count (TLC) and lactate in critically ill patients admitted with suspicion of sepsis. Methods: It was a cross sectional study conducted at the department of Chemical Pathology and Endocrinology AFIP, Rawalpindi, in collaboration with Medical and surgical intensive care units (ICU) of CMH Rawalpindi from January 2019 to December 2019. A total of 126 patients of both genders with age above 18 years and fulfilling the inclusion criteria of systemic inflammatory response syndrome (SIRS) were inducted in the study. Results: Out of 126 patients 82 (65%) patients have positive blood culture results. Male predominance was noted in patients with positive blood culture. Out of 82 patients with positive blood culture results 69(84%) patients have positive PCT results as well whereas 13(15%) patients with positive blood culture results have negative PCT values. 57(69%) patients had Gram negative bacterial infection and 25(30%) patients had Gram positive bacterial infection. Significant difference was noted between the medians of PCT in blood culture positive and blood culture negative group (p value< 0.05) whereas no significant difference was found between medians of CRP, TLC and lactate between blood culture positive and blood culture negative patients (p value > 0.05). ROC curve analysis of PCT, CRP and TLC were done, keeping blood culture as reference standard, PCT showed largest area under the curve (AUC) and clearly outperformed TLC and CRP. PCT showed AUC of 0.781 as compared to CRP and TLC, which was 0.568 and 0.617 respectively. PCT showed sensitivity of 93.9%, specificity of 47.7%, positive predictive value (PPV) of 77% and negative predictive value (NPV) of 80.8%. Conclusion: Higher NPV makes it a reliable marker for screening out sepsis in suspected cases. doi: https://doi.org/10.12669/pjms.37.7.4183 How to cite this:Bibi A, Basharat N, Aamir M, Haroon ZH. Procalcitonin as a biomarker of bacterial infection in critically ill patients admitted with suspected Sepsis in Intensive Care Unit of a tertiary care hospital. Pak J Med Sci. 2021;37(7):---------.  doi: https://doi.org/10.12669/pjms.37.7.4183 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

scholarly journals Efficacy of Yale observation scale to detect serious bacterial infection in febrile children aged one to 36 months

2015 ◽  
Vol 1 (2) ◽  
pp. 23-26
Author(s):  
Prerana Kansakar ◽  
Prakash Sundar Shrestha ◽  
Merina Shrestha
Keyword(s):  
Bacterial Infection ◽  
Febrile Illness ◽  
Cross Sectional Study ◽  
University Teaching ◽  
Cross Sectional ◽  
Predictive Values ◽  
Serious Illness ◽  
Observation Scale ◽  
Yale Observation Scale ◽  
Sensitivity Specificity

Introductions: In most children aged 1-36 months, the cause of a febrile illness is a self limiting viral infection. It is very difficult to distinguish these from serious bacterial infection. Objective of this study is to assess the efficacy of the Yale Observation Scale (YOS) to detect serious bacterial infection in febrile children aged 1-36 months.Methods: YOS scores were assigned as a part of a cross- sectional study in 100 children presenting in Tribhuvan University teaching hospital with fever to divide the child into well- looking if YOS ≤10 or ill- looking if YOS >10. Then the history, examination and necessary investigation was performed to come to a diagnosis of non- serious illness and serious bacterial infection.Results: Serious bacterial infection was found in 33(33%) of the patients. The sensitivity, specificity, positive and negative predictive values for a YOS score greater than 10 to detect serious bacterial infection were 45.45%, 88.05%%, 65.21% and 76.62%, respectively.Conclusions: A YOS ≤10 predicts non-serious illness while a YOS>10 does not necessarily indicate serious bacterial infection and should undergo further evaluation to confirm serious bacterial infection.

Interleukin-6: A Sensitive Parameter for the Early Diagnosis of Neonatal Bacterial Infection

PEDIATRICS ◽  
1994 ◽  
Vol 93 (1) ◽  
pp. 54-58 ◽  
Author(s):  
Christian Buck ◽  
Julia Bundschu ◽  
Peter Bartmann ◽  
Frank Pohlandt ◽  
Harald Gallati
Keyword(s):  
Blood Culture ◽  
Early Diagnosis ◽  
Bacterial Infection ◽  
Interleukin 6 ◽  
Early Recognition ◽  
Critical Role ◽  
Neonatal Infection ◽  
Clinical Sepsis ◽  
Sensitive Parameter ◽  
Culture Positive

Objective. Early recognition is important for the successful treatment and outcome of neonatal infections. As interleukin-6 (Il-6) plays a critical role in the induction of C-reactive protein (CRP) synthesis in the liver, it was hypothesized that this cytokine could be detected earlier in blood than the CRP during the course of bacterial infection. Design. In a prospective study of 298 newborns who were admitted to the nursery unit, CRP levels, blood cell count with differential, and Il-6 levels were determined at the time of admission and 24 hours after admission. Seventy-six newborns were excluded from the study because of incomplete or incorrect blood sampling. Results. The remaining 222 newborns were assigned to one of five groups: 11 newborns with blood culture-positive sepsis (sensitivity of Il-6 on admission 73%), 15 newborns with clinical sepsis (sensitivity of Il-6 on admission 87%), 41 newborns with infection (sensitivity of Il-6 on admission 68%), and 54 newborns without clinical and laboratory evidence of infection (specificity 78%). The remaining 101 newborns were defined as a mixed group because the diagnosis of neonatal infection could not clearly be made. Seventy-five percent of infected newborns had negative Il-6 levels 24 hours after admission. Of the 18 infected newborns with negative Il-6 levels on admission, 10 newborns had elevated CRP levels, suggesting that Il-6 was already negative because of the short half-life of Il-6. Sensitivity of Il-6 in CRP-negative newborns on admission was 100% in newborns with blood culture-positive and clinical sepsis. Il-6 was more sensitive than CRP in infected newborns on admission (73% vs 58%). Conclusion. Il-6 is a sensitive parameter for diagnosing neonatal bacterial infection. The combination of CRP and Il-6 seems to be the ideal tool for the early diagnosis of neonatal infection.

scholarly journals The Significance of Clinical and Laboratory Findings in Predicting Serious Bacterial Infections in Children With Acute Fever Without a Focus

2020 ◽  
Vol 54 (4) ◽  
pp. 195-203
Author(s):  
Hasan Demir ◽  
Medine Ayşin Taşar
Keyword(s):  
Bacterial Infection ◽  
Bacterial Infections ◽  
Blood Count ◽  
Biochemical Indicators ◽  
Clinical Scales ◽  
Severe Bacterial Infection ◽  
Observation Scale ◽  
Erythrocyte Sedimentation ◽  
Serious Bacterial Infections ◽  
Yale Observation Scale

Objective: Fever is among most common causes of admission to hospital in childhood. In 20% of febrile infants and children, no focus can be identified by physical examination and this group is defined as “acute fever without a focus” (AFWF). Bacteremia (5%), and serious bacterial infection (15%) is determined in of children with AFWF. Clinical scales and laboratory tests are used to detect the risk of occult bacteremia and serious bacterial infection in children with AFWF This study aimed to determine relation between biochemical indicators and YALE Observation Scale, besides, rates of clinical scales and biochemical indicators predicting serious bacterial infections, in 3-36 months children with AFWF. Material and Methods: This study was performed prospectively, in 77 cases, between 3-36 months of AFWF. Low risk criteria was evaluated by performing YALE Observation Scale in children. Complete blood count, absolute neutrophil count, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), interleukin 6, procalcitonin, urine analysis, chest x-ray, cerebrospinal fluid (CSF) examination; blood, urine and CSF cultures were obtained. Results: The mean age of the patients was 11.0 (4-36) months, 64.9% (n= 50) were boys. Most commonly AFWF recovered in patients (35.0%), and urinary tract infection was diagnosed (32.5%). Severe bacterial infection was determined in 44.2%. When patient groups with and without severe bacterial infection were compared, white blood count, ESH, CRP, and procalcitonin were significantly higher in severe bacterial infection (p< 0.05). Erythrocyte sedimentation rate had highest specificity (87.5%) in discriminating between groups with and without severe bacterial infection. Conclusion: In conclusion, AFWF mostly recovered in children at 3-36 months, and urinary tract infection was common cause. White cell count, ESR, CRP and procalcitonin were found valuable in predicting serious bacterial infection. Further studies are needed to predict interleukin-6 value relevant to serious bacterial infection.

scholarly journals Persistent eosinopenia is associated with in-hospital mortality among older patients: unexpected prognostic value of a revisited biomarker

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Bethsabee Partouche ◽  
Marion Pepin ◽  
Pauline Mary de Farcy ◽  
Jean-Emmanuel Kahn ◽  
Bruno Sawczynski ◽  
...  
Keyword(s):  
Multivariate Analysis ◽  
Hospital Mortality ◽  
Bacterial Infection ◽  
Neutrophil Count ◽  
Eosinophil Count ◽  
Older Patients ◽  
Predictive Ability ◽  
Mortality And Morbidity ◽  
Reactive Protein ◽  
Causes Of Mortality

Abstract Introduction Infection is one of the major causes of mortality and morbidity in older adults. Available biomarkers are not associated with prognosis in older patients. This study aimed to analyze the value of eosinopenia (eosinophil count< 100/mm3) as a prognosis marker among older patients with suspected or confirmed bacterial infection. Methods A retrospective study was performed from 1 January to 31 December 2018 among patients in a geriatrics ward suffering from a bacterial infection treated with antibiotics. Biomarker data including the eosinophil count, neutrophil count and C-reactive protein (CRP) were collected within 4 days after patient diagnosis. Persistent eosinopenia was defined as a consistent eosinophil count< 100/mm3 between Day 2 and Day 4. The association of biomarkers with 30-day hospital mortality in a multivariate analysis was assessed and their predictive ability using the area under the ROC curve (AUC) was compared. Results Our study included 197 patients with a mean age of 90 ± 6 years. A total of 36 patients (18%) died during their stay in hospital. The patients who died were more likely to have persistent eosinopenia in comparison to survivors (78% versus 34%, p < 0.001). In the multivariate analysis, persistent eosinopenia was associated with in-hospital mortality with an adjusted HR of 8.90 (95%CI 3.46–22.9). The AUC for eosinophil count, CRP and neutrophil count between Day 2 and Day 4 were 0.7650, 0.7130, and 0.698, respectively. Conclusion Persistent eosinopenia within 4 days of diagnosis of bacterial infection appeared to be a predictor of in-hospital mortality in older patients.

scholarly journals Haemoconcentration as a predictor of severity in acute pancreatitis

2016 ◽  
Vol 4 (1) ◽  
pp. 3-7
Author(s):  
Tanka Prasad Bohara ◽  
Dimindra Karki ◽  
Anuj Parajuli ◽  
Shail Rupakheti ◽  
Mukund Raj Joshi
Keyword(s):  
Acute Pancreatitis ◽  
Pearson Correlation ◽  
Characteristic Curve ◽  
Scoring Systems ◽  
Cost Effective ◽  
Receiver Operator Characteristic Curve ◽  
First Episode ◽  
P Value ◽  
Receiver Operator Characteristic ◽  
Chi Square

Background: Acute pancreatitis is usually a mild and self-limiting disease. About 25 % of patients have severe episode with mortality up to 30%. Early identification of these patients has potential advantages of aggressive treatment at intensive care unit or transfer to higher centre. Several scoring systems are available to predict severity of acute pancreatitis but are cumbersome, take 24 to 48 hours and are dependent on tests that are not universally available. Haematocrit has been used as a predictor of severity of acute pancreatitis but some have doubted its role.Objectives: To study the significance of haematocrit in prediction of severity of acute pancreatitis.Methods: Patients admitted with first episode of acute pancreatitis from February 2014 to July 2014 were included. Haematocrit at admission and 24 hours of admission were compared with severity of acute pancreatitis. Mean, analysis of variance, chi square, pearson correlation and receiver operator characteristic curve were used for statistical analysis.Results: Thirty one patients were included in the study with 16 (51.61%) male and 15 (48.4%) female. Haematocrit at 24 hours of admission was higher in severe acute pancreatitis (P value 0.003). Both haematocrit at admission and at 24 hours had positive correlation with severity of acute pancreatitis (r: 0.387; P value 0.031 and r: 0.584; P value 0.001) respectively.Area under receiver operator characteristic curve for haematocrit at admission and 24 hours were 0.713 (P value 0.175, 95% CI 0.536 - 0.889) and 0.917 (P value 0.008, 95% CI 0.813 – 1.00) respectively.Conclusion: Haematocrit is a simple, cost effective and widely available test and can predict severity of acute pancreatitis.Journal of Kathmandu Medical College, Vol. 4(1) 2015, 3-7

Sign in / Sign up

Export Citation Format

Share Document