1
|
Evans J, Umana E, Waterfield T. Respiratory viral testing for young febrile infants presenting to emergency care: a planned secondary analysis of the Febrile Infants Diagnostic assessment and Outcome (FIDO) prospective observational cohort study. Arch Dis Child 2024:archdischild-2024-327567. [PMID: 39357988 DOI: 10.1136/archdischild-2024-327567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2024] [Accepted: 09/17/2024] [Indexed: 10/04/2024]
Abstract
OBJECTIVE To describe the association of respiratory viral test results and the risk of invasive bacterial infection (IBI) for febrile young infants presenting to emergency care. DESIGN A planned secondary analysis within the Febrile Infants Diagnostic assessment and Outcome (FIDO) study, a prospective multicentre observational cohort study conducted across the UK and Ireland. SETTING 35 paediatric emergency departments and assessment units across the UK and Ireland between 6 July 2022 and 31 August 2023. PATIENTS Febrile infants aged 90 days and under presenting to emergency care. MAIN OUTCOME MEASURES IBI (meningitis or bacteraemia) among febrile infants, undergoing respiratory viral testing for respiratory syncytial virus (RSV), influenza and SARS-CoV-2. RESULTS 1395 out of 1821 participants underwent respiratory viral testing, of those tested 339 (24.5%) tested positive for at least one of, SARS-CoV-2, RSV or influenza. A total of 45 infants (3.2%) were diagnosed with IBI. Of these, IBI occurred in 40 out of 1056 (3.8%) participants with a negative viral test and 5 out of 339 (1.5%) occurred in participants with a positive viral respiratory test (p=0.034). Infants aged 29 days and older with a positive respiratory viral test had a significantly lower rate of IBI (0.7%) compared with those with a negative test (3.2%) (p=0.015). CONCLUSIONS Young febrile infants with a positive respiratory viral test for SARS-CoV-2, RSV or influenza are at lower risk of IBI. Infants over 28 days of age with a positive viral test represent the lowest risk cohort. TRIAL REGISTRATION NUMBER NCT05259683.
Collapse
Affiliation(s)
- Jordan Evans
- Paediatric Emergency Unit, University Hospital of Wales, Cardiff and Vale University Health Board, Cardiff, UK
- Health and Care Research Wales, Cardiff, UK
| | - Etimbuk Umana
- Wellcome-Wolfson Institute for Experimental Medicine, Queen's University Belfast, Belfast, UK
| | - Thomas Waterfield
- Wellcome Wolfson Institute for Experimental Medicine, Queen's University Belfast School of Medicine Dentistry and Biomedical Sciences, Belfast, UK
| |
Collapse
|
2
|
Yaeger JP, Jones J, Ertefaie A, Caserta MT, Fiscella KA. Derivation of a clinical-based model to detect invasive bacterial infections in febrile infants. J Hosp Med 2022; 17:893-900. [PMID: 36036211 PMCID: PMC9633417 DOI: 10.1002/jhm.12956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Revised: 07/28/2022] [Accepted: 08/15/2022] [Indexed: 11/10/2022]
Abstract
BACKGROUND Febrile infants are at risk for invasive bacterial infections (IBIs) (i.e., bacteremia and bacterial meningitis), which, when undiagnosed, may have devastating consequences. Current IBI predictive models rely on serum biomarkers, which may not provide timely results and may be difficult to obtain in low-resource settings. OBJECTIVE The aim of this study was to derive a clinical-based IBI predictive model for febrile infants. DESIGNS, SETTING, AND PARTICIPANTS This is a cross-sectional study of infants brought to two pediatric emergency departments from January 2011 to December 2018. Inclusion criteria were age 0-90 days, temperature ≥38°C, and documented gestational age, fever duration, and illness duration. MAIN OUTCOME AND MEASURES To detect IBIs, we used regression and ensemble machine learning models and evidence-based predictors (i.e., sex, age, chronic medical condition, gestational age, appearance, maximum temperature, fever duration, illness duration, cough status, and urinary tract inflammation). We up-weighted infants with IBIs 8-fold and used 10-fold cross-validation to avoid overfitting. We calculated the area under the receiver operating characteristic curve (AUC), prioritizing a high sensitivity to identify the optimal cut-point to estimate sensitivity and specificity. RESULTS Of 2311 febrile infants, 39 had an IBI (1.7%); the median age was 54 days (interquartile range: 35-71). The AUC was 0.819 (95% confidence interval: 0.762, 0.868). The predictive model achieved a sensitivity of 0.974 (0.800, 1.00) and a specificity of 0.530 (0.484, 0.575). Findings suggest that a clinical-based model can detect IBIs in febrile infants, performing similarly to serum biomarker-based models. This model may improve health equity by enabling clinicians to estimate IBI risk in any setting. Future studies should prospectively validate findings across multiple sites and investigate performance by age.
Collapse
Affiliation(s)
- Jeffrey P Yaeger
- Department of Pediatrics, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
- Department of Public Health Sciences, University of Rochester Medical Center, Rochester, New York, USA
| | - Jeremiah Jones
- Department of Biostatistics and Computational Biology, University of Rochester Medical Center, Rochester, New York, USA
| | - Ashkan Ertefaie
- Department of Biostatistics and Computational Biology, University of Rochester Medical Center, Rochester, New York, USA
| | - Mary T Caserta
- Department of Pediatrics, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
| | - Kevin A Fiscella
- Department of Family Medicine, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
| |
Collapse
|
3
|
Yaeger JP, Jones J, Ertefaie A, Caserta MT, van Wijngaarden E, Fiscella K. Refinement and Validation of a Clinical-Based Approach to Evaluate Young Febrile Infants. Hosp Pediatr 2022; 12:399-407. [PMID: 35347337 DOI: 10.1542/hpeds.2021-006214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND AND OBJECTIVE For febrile infants, predictive models to detect bacterial infections are available, but clinical adoption remains limited by implementation barriers. There is a need for predictive models using widely available predictors. Thus, we previously derived 2 novel predictive models (machine learning and regression) by using demographic and clinical factors, plus urine studies. The objective of this study is to refine and externally validate the predictive models. METHODS This is a cross-sectional study of infants initially evaluated at one pediatric emergency department from January 2011 to December 2018. Inclusion criteria were age 0 to 90 days, temperature ≥38°C, documented gestational age, and insurance type. To reduce potential biases, we derived models again by using derivation data without insurance status and tested the ability of the refined models to detect bacterial infections (ie, urinary tract infection, bacteremia, and meningitis) in the separate validation sample, calculating areas-under-the-receiver operating characteristic curve, sensitivities, and specificities. RESULTS Of 1419 febrile infants (median age 53 days, interquartile range = 32-69), 99 (7%) had a bacterial infection. Areas-under-the-receiver operating characteristic curve of machine learning and regression models were 0.92 (95% confidence interval [CI] 0.89-0.94) and 0.90 (0.86-0.93) compared with 0.95 (0.91-0.98) and 0.96 (0.94-0.98) in the derivation study. Sensitivities and specificities of machine learning and regression models were 98.0% (94.7%-100%) and 54.2% (51.5%-56.9%) and 96.0% (91.5%-99.1%) and 50.0% (47.4%-52.7%). CONCLUSIONS Compared with the derivation study, the machine learning and regression models performed similarly. Findings suggest a clinical-based model can estimate bacterial infection risk. Future studies should prospectively test the models and investigate strategies to optimize clinical adoption.
Collapse
Affiliation(s)
- Jeffrey P Yaeger
- Departments of Pediatrics, and.,Public Health Sciences, University of Rochester Medical Center, Rochester, New York
| | | | | | | | | | - Kevin Fiscella
- Family Medicine, University of Rochester School of Medicine and Dentistry, Rochester, New York
| |
Collapse
|
4
|
Yaeger JP, Lu J, Jones J, Ertefaie A, Fiscella K, Gildea D. Derivation of a natural language processing algorithm to identify febrile infants. J Hosp Med 2022; 17:11-18. [PMID: 35504534 DOI: 10.1002/jhm.2732] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Revised: 11/24/2021] [Accepted: 12/09/2021] [Indexed: 11/08/2022]
Abstract
BACKGROUND Diagnostic codes can retrospectively identify samples of febrile infants, but sensitivity is low, resulting in many febrile infants eluding detection. To ensure study samples are representative, an improved approach is needed. OBJECTIVE To derive and internally validate a natural language processing algorithm to identify febrile infants and compare its performance to diagnostic codes. METHODS This cross-sectional study consisted of infants aged 0-90 days brought to one pediatric emergency department from January 2016 to December 2017. We aimed to identify infants with fever, defined as a documented temperature ≥38°C. We used 2017 clinical notes to develop two rule-based algorithms to identify infants with fever and tested them on data from 2016. Using manual abstraction as the gold standard, we compared performance of the two rule-based algorithms (Models 1, 2) to four previously published diagnostic code groups (Models 5-8) using area under the receiver-operating characteristics curve (AUC), sensitivity, and specificity. RESULTS For the test set (n = 1190 infants), 184 infants were febrile (15.5%). The AUCs (0.92-0.95) and sensitivities (86%-92%) of Models 1 and 2 were significantly greater than Models 5-8 (0.67-0.74; 20%-74%) with similar specificities (93%-99%). In contrast to Models 5-8, samples from Models 1 and 2 demonstrated similar characteristics to the gold standard, including fever prevalence, median age, and rates of bacterial infections, hospitalizations, and severe outcomes. CONCLUSIONS Findings suggest rule-based algorithms can accurately identify febrile infants with greater sensitivity while preserving specificity compared to diagnostic codes. If externally validated, rule-based algorithms may be important tools to create representative study samples, thereby improving generalizability of findings.
Collapse
Affiliation(s)
- Jeffrey P Yaeger
- Department of Pediatrics, University of Rochester Medical Center, Rochester, New York, USA
- Department of Public Health Sciences, University of Rochester Medical Center, Rochester, New York, USA
| | - Jiahao Lu
- Department of Pediatrics, University of Rochester Medical Center, Rochester, New York, USA
| | - Jeremiah Jones
- Department of Biostatistics and Computational Biology, University of Rochester Medical Center, Rochester, New York, USA
| | - Ashkan Ertefaie
- Department of Biostatistics and Computational Biology, University of Rochester Medical Center, Rochester, New York, USA
| | - Kevin Fiscella
- Department of Family Medicine, University of Rochester Medical Center, Rochester, New York, USA
| | - Daniel Gildea
- Department of Computer Science, University of Rochester, Rochester, New York, USA
| |
Collapse
|
5
|
Yaeger JP, Jones J, Ertefaie A, Caserta MT, van Wijngaarden E, Fiscella K. Using Clinical History Factors to Identify Bacterial Infections in Young Febrile Infants. J Pediatr 2021; 232:192-199.e2. [PMID: 33421424 DOI: 10.1016/j.jpeds.2020.12.079] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 12/30/2020] [Accepted: 12/31/2020] [Indexed: 12/23/2022]
Abstract
OBJECTIVE To develop a novel predictive model using primarily clinical history factors and compare performance to the widely used Rochester Low Risk (RLR) model. STUDY DESIGN In this cross-sectional study, we identified infants brought to one pediatric emergency department from January 2014 to December 2016. We included infants age 0-90 days, with temperature ≥38°C, and documented gestational age and illness duration. The primary outcome was bacterial infection. We used 10 predictors to develop regression and ensemble machine learning models, which we trained and tested using 10-fold cross-validation. We compared areas under the curve (AUCs), sensitivities, and specificities of the RLR, regression, and ensemble models. RESULTS Of 877 infants, 67 had a bacterial infection (7.6%). The AUCs of the RLR, regression, and ensemble models were 0.776 (95% CI 0.746, 0.807), 0.945 (0.913, 0.977), and 0.956 (0.935, 0.975), respectively. Using a bacterial infection risk threshold of .01, the sensitivity and specificity of the regression model was 94.6% (87.4%, 100%) and 74.5% (62.4%, 85.4%), compared with 95.5% (87.5%, 99.1%) and 59.6% (56.2%, 63.0%) using the RLR model. CONCLUSIONS Compared with the RLR model, sensitivities of the novel predictive models were similar whereas AUCs and specificities were significantly greater. If externally validated, these models, by producing an individualized bacterial infection risk estimate, may offer a targeted approach to young febrile infants that is noninvasive and inexpensive.
Collapse
Affiliation(s)
- Jeffrey P Yaeger
- Department of Pediatrics, University of Rochester School of Medicine and Dentistry, Rochester, NY; Department of Public Health Sciences, University of Rochester Medical Center, Rochester, NY.
| | - Jeremiah Jones
- Department of Biostatistics and Computational Biology, University of Rochester Medical Center, Rochester, NY
| | - Ashkan Ertefaie
- Department of Biostatistics and Computational Biology, University of Rochester Medical Center, Rochester, NY
| | - Mary T Caserta
- Department of Pediatrics, University of Rochester School of Medicine and Dentistry, Rochester, NY
| | - Edwin van Wijngaarden
- Department of Public Health Sciences, University of Rochester Medical Center, Rochester, NY
| | - Kevin Fiscella
- Department of Family Medicine, University of Rochester School of Medicine and Dentistry, Rochester, NY
| |
Collapse
|
6
|
Liu CE, Pan YM, Du ZL, Wu C, Hong XY, Sun YH, Li HF, Liu J. Composition characteristics of the gut microbiota in infants and young children of under 6 years old between Beijing and Japan. Transl Pediatr 2021; 10:790-806. [PMID: 34012829 PMCID: PMC8107842 DOI: 10.21037/tp-20-376] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND The composition of intestinal flora in Chinese and Japanese has been reported in many studies but that in infants aged 0-6 years old has not been studied yet. METHODS The distribution characteristics of the fecal flora of infants in Beijing (n=84) and Japan (n=53) were analyzed using 16S rRNA gene sequencing analysis. RESULTS This study showed the higher relative abundance of Erysipelotrichaceae_ UCG-003 and Anaerostipes in male group that of Ruminiclostridium, Eubacterium, Senegalimassilia and Senegalimassilia in female group, especially Senegalimassilia, which was not detected in male group. Defecation trait groups indicated significantly higher relative abundance of Bifidobacterium in abnormal bowel trait group than that in the normal group (P<0.05). The feeding groups' analysis showed significantly higher relative abundance of Bifidobacterium and Enterococcus and lower abundance of Bacteroides and Lacetospirillaceae in the breast-feeding group than that in the formula feeding and mixed-feeding groups. The relative abundance of Parasutterella and Ruminococcaceae_UCG-003 in the halitosis group was significantly higher than that in the normal group. The comparison of cold and fever group and normal group indicated significantly higher relative abundance of Erysipelatoclostridium and lower relative abundance of Lachnospiraceae _UCG-001 in the fever and cold group than that in the normal group (P<0.05). The regional comparison of intestinal flora of Beijing and Japan showed significant increase in the relative abundance of Bacillus, Lactobacillus, Prevotella, megamonas and Veillonella in the intestinal flora of 0-6 years old infants in Beijing. CONCLUSIONS These findings improve the understanding of intestinal bacterial and viral communities of infants from the two Asian countries.
Collapse
Affiliation(s)
- Chang-E Liu
- Department of Nutrition, the Seventh Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Yuan-Ming Pan
- Department of Gastroenterology, the Seventh Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Zhen-Lan Du
- Department of Hematology and Oncology, Faculty of Pediatrics, Chinese PLA General Hospital, Beijing, China
| | - Cong Wu
- Department of Nutrition, the Seventh Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Xiao-Yang Hong
- Department of Critical Care Medicine, Faculty of Pediatrics, Chinese PLA General Hospital, Beijing, China
| | - Yan-Hui Sun
- Department of Nutrition, the Seventh Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Hai-Feng Li
- Department of Health Services, the Seventh Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Jie Liu
- Department of Laboratory, the Seventh Medical Center of PLA General Hospital, Beijing, China
| |
Collapse
|