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Waterfield T, Lyttle MD, Munday C, Foster S, McNulty M, Platt R, Barrett M, Rogers E, Durnin S, Jameel N, Maney JA, McGinn C, McFetridge L, Mitchell H, Puthucode D, Roland D. Validating clinical practice guidelines for the management of febrile infants presenting to the emergency department in the UK and Ireland. Arch Dis Child 2022; 107:329-334. [PMID: 34531196 DOI: 10.1136/archdischild-2021-322586] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Accepted: 09/03/2021] [Indexed: 12/24/2022]
Abstract
OBJECTIVE To report the performance of clinical practice guidelines (CPG) in the diagnosis of serious/invasive bacterial infections (SBI/IBI) in infants presenting with a fever to emergency care in the UK and Ireland. Two CPGs were from the National Institutes for Health and Care Excellence (NICE guidelines NG51 and NG143) and one was from the British Society for Antimicrobial Chemotherapy (BSAC). DESIGN Retrospective multicentre cohort study. PATIENTS Febrile infants aged 90 days or less attending between the 31 August 2018 to 1 September 2019. MAIN OUTCOME MEASURES The sensitivity, specificity and predictive values of CPGs in identifying SBI and IBI. SETTING Six paediatric Emergency Departments in the UK/Ireland. RESULTS 555 participants were included in the analysis. The median age was 53 days (IQR 32 to 70), 447 (81%) underwent blood testing and 421 (76%) received parenteral antibiotics. There were five participants with bacterial meningitis (1%), seven with bacteraemia (1%) and 66 (12%) with urinary tract infections. The NICE NG51 CPG was the most sensitive: 1.00 (95% CI 0.95 to 1.00). This was significantly more sensitive than NICE NG143: 0.91 (95% CI 0.82 to 0.96, p=0.0233) and BSAC: 0.82 (95% 0.72 to 0.90, p=0.0005). NICE NG51 was the least specific 0.0 (95% CI 0.0 to 0.01), and this was significantly lower than the NICE NG143: 0.09 (95% CI 0.07 to 0.12, p<0.0001) and BSAC: 0.14 (95% CI 0.1 to 0.17, p<0.0001). CONCLUSION None of the studied CPGs demonstrated ideal performance characteristics. CPGs should be improved to guide initial clinical decision making. TRIAL REGISTRATION NUMBER NCT04196192.
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Affiliation(s)
- Thomas Waterfield
- Wellcome-Wolfson Institute for Experimental Medicine, Queen's University Belfast, Belfast, UK
| | - Mark D Lyttle
- Emergency Department, Bristol Royal Hospital for Children, Bristol, UK.,Faculty of Health and Applied Sciences, University of the West of England, Bristol, UK
| | - Charlotte Munday
- Emergency Department, Bristol Royal Hospital for Children, Bristol, UK
| | - Steven Foster
- Emergency Department, Royal Hospital for Children, Glasgow, UK
| | - Marc McNulty
- Emergency Department, Royal Hospital for Children, Glasgow, UK
| | - Rebecca Platt
- Emergency Department, Barts Health NHS Trust, London, UK
| | - Michael Barrett
- Emergency Department, Children's Health Ireland at Crumlin, Crumlin, Ireland.,Women's and Children's Health, School of Medicine, University College Dublin, Dublin, Ireland
| | - Emma Rogers
- Emergency Department, Children's Health Ireland at Crumlin, Crumlin, Ireland
| | - Sheena Durnin
- Emergency Department, Children's Health Ireland at Tallaght, Dublin, Ireland.,Discipline of Paediatrics, Trinity College, University of Dublin, Dublin, Ireland
| | - Nida Jameel
- Emergency Department, Children's Health Ireland at Tallaght, Dublin, Ireland
| | - Julie-Ann Maney
- Emergency Department, Royal Belfast Hospital for Sick Children, Belfast, UK
| | - Claire McGinn
- Emergency Department, Royal Belfast Hospital for Sick Children, Belfast, UK
| | - Lisa McFetridge
- Mathematical Sciences Research Centre, Queen's University Belfast, Belfast, UK
| | - Hannah Mitchell
- Mathematical Sciences Research Centre, Queen's University Belfast, Belfast, UK
| | - Deepika Puthucode
- Children's Emergency Department, Leicester Royal Infirmary, Leicester, UK
| | - Damian Roland
- Department of Health Sciences, University of Leicester, Leicester, UK.,Paediatric Emergency Medicine Leicester Academic (PEMLA) Group, University Hospitals of Leicester NHS Trust, Leicester, UK
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