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Diagnosing serious infections in acutely ill children in ambulatory care (ERNIE 2 study protocol, part A): diagnostic accuracy of a clinical decision tree and added value of a point-of-care C-reactive protein test and oxygen saturation

Jan Y Verbakel, Marieke Lemiengre UGent, Tine De Burghgraeve, An De Sutter UGent, Dominique A Bullens, Bert Aertgeerts and Frank Buntinx (2014) BMC PEDIATRICS. 14.
abstract
Background: Acute illness is the most common presentation of children to ambulatory care. In contrast, serious infections are rare and often present at an early stage. To avoid complications or death, early recognition and adequate referral are essential. In a recent large study children were included prospectively to construct a symptom-based decision tree with a sensitivity and negative predictive value of nearly 100%. To reduce the number of false positives, point-of-care tests might be useful, providing an immediate result at bedside. The most probable candidate is C-reactive protein, as well as a pulse oximetry. Methods: This is a diagnostic accuracy study of signs, symptoms and point-of-care tests for serious infections. Acutely ill children presenting to a family physician or paediatrician will be included consecutively in Flanders, Belgium. Children testing positive on the decision tree will get a point-of-care C-reactive protein test. Children testing negative will randomly either receive a point-of-care C-reactive protein test or usual care. The outcome of interest is hospital admission more than 24 hours with a serious infection within 10 days. Aiming to include over 6500 children, we will report the diagnostic accuracy of the decision tree (+/- the point-of-care C-reactive protein test or pulse oximetry) in sensitivity, specificity, positive and negative likelihood ratios, and positive and negative predictive values. New diagnostic algorithms will be constructed through classification and regression tree and multiple logistic regression analysis. Discussion: We aim to improve detection of serious infections, and present a practical tool for diagnostic triage of acutely ill children in primary care. We also aim to reduce the number of investigations and admissions in children with non-serious infections.
Please use this url to cite or link to this publication:
author
organization
year
type
journalArticle (original)
publication status
published
subject
keyword
Diagnostic accuracy, Safety netting, C-reactive protein/analysis, Infant, Acute illness, Point-of-care systems, Serious infections, Child, SAMPLE-SIZE CALCULATION, FEBRILE CHILDREN, BACTERIAL-INFECTION, PREDICTION RULES, SIGNS, PROCALCITONIN, PNEUMONIA, EMERGENCY, SYMPTOMS
journal title
BMC PEDIATRICS
BMC Pediatrics
volume
14
article number
207
pages
7 pages
Web of Science type
Article
Web of Science id
000344892500001
JCR category
PEDIATRICS
JCR impact factor
1.93 (2014)
JCR rank
41/120 (2014)
JCR quartile
2 (2014)
ISSN
1471-2431
DOI
10.1186/1471-2431-14-207
project
ERNIE2
language
English
UGent publication?
yes
classification
A1
copyright statement
I have retained and own the full copyright for this publication
id
5842793
handle
http://hdl.handle.net/1854/LU-5842793
date created
2015-02-09 16:18:19
date last changed
2017-03-07 12:17:34
@article{5842793,
  abstract     = {Background: Acute illness is the most common presentation of children to ambulatory care. In contrast, serious infections are rare and often present at an early stage. To avoid complications or death, early recognition and adequate referral are essential. In a recent large study children were included prospectively to construct a symptom-based decision tree with a sensitivity and negative predictive value of nearly 100\%. To reduce the number of false positives, point-of-care tests might be useful, providing an immediate result at bedside. The most probable candidate is C-reactive protein, as well as a pulse oximetry. 
Methods: This is a diagnostic accuracy study of signs, symptoms and point-of-care tests for serious infections. Acutely ill children presenting to a family physician or paediatrician will be included consecutively in Flanders, Belgium. Children testing positive on the decision tree will get a point-of-care C-reactive protein test. Children testing negative will randomly either receive a point-of-care C-reactive protein test or usual care. The outcome of interest is hospital admission more than 24 hours with a serious infection within 10 days. Aiming to include over 6500 children, we will report the diagnostic accuracy of the decision tree (+/- the point-of-care C-reactive protein test or pulse oximetry) in sensitivity, specificity, positive and negative likelihood ratios, and positive and negative predictive values. New diagnostic algorithms will be constructed through classification and regression tree and multiple logistic regression analysis. 
Discussion: We aim to improve detection of serious infections, and present a practical tool for diagnostic triage of acutely ill children in primary care. We also aim to reduce the number of investigations and admissions in children with non-serious infections.},
  articleno    = {207},
  author       = {Verbakel, Jan Y and Lemiengre, Marieke and De Burghgraeve, Tine and De Sutter, An and Bullens, Dominique A and Aertgeerts, Bert and Buntinx, Frank},
  issn         = {1471-2431},
  journal      = {BMC PEDIATRICS},
  keyword      = {Diagnostic accuracy,Safety netting,C-reactive protein/analysis,Infant,Acute illness,Point-of-care systems,Serious infections,Child,SAMPLE-SIZE CALCULATION,FEBRILE CHILDREN,BACTERIAL-INFECTION,PREDICTION RULES,SIGNS,PROCALCITONIN,PNEUMONIA,EMERGENCY,SYMPTOMS},
  language     = {eng},
  pages        = {7},
  title        = {Diagnosing serious infections in acutely ill children in ambulatory care (ERNIE 2 study protocol, part A): diagnostic accuracy of a clinical decision tree and added value of a point-of-care C-reactive protein test and oxygen saturation},
  url          = {http://dx.doi.org/10.1186/1471-2431-14-207},
  volume       = {14},
  year         = {2014},
}

Chicago
Verbakel, Jan Y, Marieke Lemiengre, Tine De Burghgraeve, An De Sutter, Dominique A Bullens, Bert Aertgeerts, and Frank Buntinx. 2014. “Diagnosing Serious Infections in Acutely Ill Children in Ambulatory Care (ERNIE 2 Study Protocol, Part A): Diagnostic Accuracy of a Clinical Decision Tree and Added Value of a Point-of-care C-reactive Protein Test and Oxygen Saturation.” Bmc Pediatrics 14.
APA
Verbakel, J. Y., Lemiengre, M., De Burghgraeve, T., De Sutter, A., Bullens, D. A., Aertgeerts, B., & Buntinx, F. (2014). Diagnosing serious infections in acutely ill children in ambulatory care (ERNIE 2 study protocol, part A): diagnostic accuracy of a clinical decision tree and added value of a point-of-care C-reactive protein test and oxygen saturation. BMC PEDIATRICS, 14.
Vancouver
1.
Verbakel JY, Lemiengre M, De Burghgraeve T, De Sutter A, Bullens DA, Aertgeerts B, et al. Diagnosing serious infections in acutely ill children in ambulatory care (ERNIE 2 study protocol, part A): diagnostic accuracy of a clinical decision tree and added value of a point-of-care C-reactive protein test and oxygen saturation. BMC PEDIATRICS. 2014;14.
MLA
Verbakel, Jan Y, Marieke Lemiengre, Tine De Burghgraeve, et al. “Diagnosing Serious Infections in Acutely Ill Children in Ambulatory Care (ERNIE 2 Study Protocol, Part A): Diagnostic Accuracy of a Clinical Decision Tree and Added Value of a Point-of-care C-reactive Protein Test and Oxygen Saturation.” BMC PEDIATRICS 14 (2014): n. pag. Print.