Validity of Royal College of Paediatrics and Child Health Score to Predict Serious.
I WAYAN GUSTAWAN
1
Background
the increase of child mortality in developing country,
the high incidence of serious bacterial infection in
children,
the variety of risk factors of serious infections,
current scoring model has not been tested in limited
health care centre.
Craig JC, Williams GJ, Jones M, Codarini M, Macaskill P, Hayen A, et al. The accuracy of clinical symptoms and signs for the
diagnosis of serious bacterial infection in young febrile children: prospective cohort study of 15 781 febrile illnesses. BMJ
2010;340:1-12
Opiyo N, English M. What clinical signs best identify severe illness in young infants aged 0–59 days in developing countries? A
systematic review. Arch Dis Child. 2011;96:1052–59
2
Background……
In clinical practice, discriminating children with SBI
from those with other self limiting infections is
challenging.
A simple, validated clinical tool to risk stratify and
guide further management of children with suspected
SBI would greatly improve their care.
Craig JC, Williams GJ, Jones M, Codarini M, Macaskill P, Hayen A, et al. The accuracy of clinical symptoms and signs for the
diagnosis of serious bacterial infection in young febrile children: prospective cohort study of 15 781 febrile illnesses. BMJ
2010;340:1-12
Opiyo N, English M. What clinical signs best identify severe illness in young infants aged 0–59 days in developing countries? A
systematic review. Arch Dis Child. 2011;96:1052–59
3
Objective.
to know the validity of of Royal College of Paediatrics
and Child Health Score (SBI score) to predict serious
bacterial infection in children with fever and
Validity of SBI score in different cut off point
Validity of SBI score based on age category
to find predictor factors of the serious infection.
4
Method.
Diagnostic study was used to find validity of RCPCH
Score and cohort prospective study to find predictor
factors of the serious infection.
Gold standard was the latest diagnosis noted on
medical record based on ICD-10.
All tests were done blind.
5
Sample Population : febrile children 1 months-12
years old who was come to emergency department and
policlinic Sanglah Hospital that eligible for inclusion
and exclusion criteria.
Convenient sampling
January - December 2014.
6
Inclusion criteria :
1. Febrile children less than 7 days,
2. Come first time for that febrile episode and
accompanied by parents,
3. Parents agree to joint in this study.
Exclusion criteria :
• Febrile children with emergency condition,
• Parent didn’t have hand phone or home
number.
7
8
9
Statistical Methods :
Analysis were performed using computer
Sensitivity, specificity, positive predictive value, negative
predictive value, positive likelihood rasio, negative
likelihood rasio, post test probability, area under ROC curve
were reported
Logistic regression were performed to find predictor factor
for SBI
Ethics approval was granted by the Ethics Comitte (Badan
Litbang FK UNUD/RSUP Sanglah Denpasar).
10
Results
There were 260 subjects. Seven patients of out-patient
department could not be reached so analysis was done
on 253 subjects (97.3%).
There were more male than female with the ratio of
1.14:1.
Age group of >36 months dominated the subject
population (51.4%).
Serious bacterial infection was found on 28.9% subject
with the most diagnosis was pneumonia (19%).
11
12
Table 9. Characteristic of study populations (n =253)
Variable
Age (n, %)
1-36 months
> 36 months
Sex (n, %)
Male
Female
Status of patients (n, %)
Hospitalized
Ambulatory
Laboratory examination
WBC, n = 241 (n, mean)
SBI
Non SBI
CRP, n = 44 (n, mean)
SBI
Non SBI
Procalsitonin, n = 24 (n, mean)
SBI
Non SBI
Blood culture, n = 57 (n, %)
Bacteremia
No growth
123 (48,6)
130 (51,4)
135 (53,4)
118 (46,6)
239 (94,5)
14 (5,5)
72 (16,99 x 103/ul)
169 (7,97 x 103/ul))
33 (31,85 mg/L)
11 (3,77 mg/L)
20 (65,35 ng/ml)
4 (8,5 ng/ml)
15 (26,3)
42 (73,7)
WBC white blood cell; SBI serious bacterial infection; CRP C-reactive protein.
13
Table 10. Distribution of diagnosis
Diagnosis
SBI
Acute Otitis Media
Empiema
Pneumonia
Diarrhea by bacterial infection
Sepsis
Tonsilopharyngitis bacterial
Urinary tract infection
Non SBI
Dengue Shock Syndrome
Dengue Hemorrhagic Fever
Dengue fever
Febrile convulsion
Bronchiolitis
Ensephalitis
Diarrhea by viral infection
Others
n (%)
4 (1,6)
3 (1,2)
48 (19,0)
4 (1,6)
6 (2,4)
3 (1,2)
5(2,0)
22 (8,7)
49 (19,4)
31 (12,3)
16 (6,3)
9 (3,6)
6 (2,4)
5 (2,01)
42 (16,7)
SBI serious bacterial infection
14
Table 11. Validity of SBI score to evaluate serious bacterial infection in febrile children
Diagnosis
SBI score
Total
SBI
Non SBI
SBI
43
24
67
Non SBI
30
156
186
Total
73
180
253
Sensitivity 58,9% (95% CI 47,5-69,5), specificity 86,7% (95% CI 80,9-90,9),
positive predictive value 64,2% (95% CI 54,2-73,1), negative predictive value
83,8% (95% CI 79,7- 87,3), positive likelihood rasio 4,42 (95% CI 2,91-6,72),
negative likelihood rasio 0,47 (95% CI 0,36-0,63), post test probability 64,23
per 100 (95% CI 54,2-73,1), area under ROC curve 72,8% (95% CI 66,6-79,0).
15
Table 12. Diagnostic test of SBI score in different cut off point
Cut off point SBI score to predict SBI
3
95% CI
4
95% CI
5
95% CI
6
95% CI
7
95% CI
Sens
87,7
78,2-93,4
71,2
59,9-80,4
58,9
47,5-69,5
34,2
24,4-45,7
24,7
16,2-35,64
Spec
43,9
36,8-51,2
70,0
62,9-76,2
86,7
80,9-90,9
91,6
86,7-94,9
96,7
92,9-98,5
PPV
38,8
35,2-42,6
49,1
42,5-55,8
64,2
54,2-73,1
62,6
48,5-74,8
75,0
56,1-87,6
NPV
89,8
82,5-94,2
85,7
80,5-89,7
83,8
79,7-87,3
77,4
74,3-80,3
75,9
73,4-78,3
PLR
1,6
1,3-1,8
2,4
1,8-3,1
4,4
2,9-6,7
4,1
2,3-7,3
7,4
3,1-17,9
NLR
0,3
0,2-0,5
0,4
0,3-0,6
0,5
0,4-0,6
0,7
0,6-0,9
0,8
0,7-0,9
Prevalens
28,9
PTP
38,4
35,2-42,6
49,11
42,5-55,8
64,2
54,2-73,1
62,55
48,5-74,8
75,04
56,1-87,6
AUC
65,8
60,5-71,0
70,6
64,4-76,8
72,8
66,6-79,0
63,0
57,2-68,8
60,7
55,5-65,8
28,9
28,9
28,9
28,9
Sens Sensitivity; Spes specificity, PPV positive predictive value; NPV negative predictive value; PLR
positive likelihood rasio; NLR negative likelihood rasio; PTP post test probability; AUC area under ROC
curve
16
Tabel 13. Diagnostic test of SBI score based on age category
Diagnostic test of SBI score based on age
1-36 bulan
95% CI
> 36 bulan
95% CI
Sens (%)
61,40
48,43-72,94
50,00
28,00-72,00
Spec (%)
80,30
69,16-88,11
90,35
83,54-94,53
PPV (%)
72,9
61,48-81,95
42,1
25,8-60,3
NPV (%)
70,7
62,98-77,33
92,8
88,72-95,48
PLR (%)
3,12
1,84-5,29
5,18
2,46-10,92
NLR (%)
0,48
0,34-0,68
0,55
0,34-0,91
Prevalence
46,3
PTP (%)
72,92
61,48-81,95
42,09
25,80-60,30
AUC (%)
70,9
62,9-78,8
70,2
57,6-82,7
12,3
Sens Sensitivity; Spes specificity, PPV positive predictive value; NPV negative predictive value; PLR
positive likelihood rasio; NLR negative likelihood rasio; PTP post test probability; AUC area under
ROC curve
17
Table 14. Univariate Analysis of predictor for serious bacterial infection
No
Variable
SBI
Non SBI
p
N
%
N
%
Age
1-36 months
>36 months
57
16
46,3
12,3
66
114
53,7
87,7
0,001
2
Sex; male
45
33,3
90
66,7
0,093
3
Duration of
(n,median)
73
4,09
180
4,18
0,624**
4
Cough
52
52,0
48
48,0
5
Rhinorrhea
41
48,8
43
6
Breathing difficulty
44
74,6
7
Diarrhea
10
8
Convulsion
9
OR
95%CI
Min
Max
6,2
3,2
11,6
1,6
0,9
2,7
0,001
6,8
3,7
12,5
51,2
0,001
4,1
2,3
7,3
15
25,4
0,001
16,5
8,2
33,6
41,7
14
58,3
0,149
1,9
0,8
4,4
2
6,5
29
93,5
0,003*
6,8
1,6
29,4
Unconsciousness
6
20,0
24
80,0
0,254
1,1
0,9
1,4
10
Dysuria
0
0
2
100,0
1,000*
1,4
1,3
1,5
11
Development delay
4
50,0
4
50,0
0,233*
2,6
0,6
10,5
12
Risk of infection
32
32,3
67
67,7
0,329
1,3
0,8
2,3
13
State variation
Eye closed
23
46,0
27
54,0
0,003
2,6
1,3
4,9
14
Temperature ≥ 37,5
71
35,7
128
64,3
0,001
14,4
3,4
60,9
15
CRT >2 s
12
25,0
36
75,0
0,513
0,8
0,4
1,6
16
Dehydration
12
50,0
12
50,0
0,016
2,8
1,2
6,5
17
Tachypnoea
51
64,6
28
35,4
0,001
12,6
6,6
23,9
18
Hypoxia
30
65,2
16
34,8
0,001
7,2
3,6
14,3
1
CRT Capillary refill time
*Uji Fisher
**Uji Mann-Whitney
fever
18
Table 15. Multivariate Analysis of predictor for serious bacterial infections
Step
Variabel
Step 6
Cough
Breathing difficulty
Diarrhea
Convulsion
Age
Temperature
Hipoxia
Tachypnoea
Constanta
B
OR
P
1,036
0,951
1,285
2,487
0,859
2,055
1,236
1,033
-7,119
2,819
2,589
3,614
12,027
2,360
7,809
3,441
2,810
0,010
0,023
0,064
0,029
0,003
0,051
0,016
0,012
0,026
0,000
95% CI
Min
Max
1,153
6,891
0,945
7,098
1,140 11,455
2,374 60,886
0,997
5,586
1,476 41,305
1,318
8,984
1,135
6,960
19
DISCUSSION
Clinical scoring model to predict SBI in children was less
reported.
Brent et al demonstrates the potential utility of a clinical score
in risk stratifying children with suspected SBI Royal
College of Paediatrics and Child Health score (SBI score)
Validation of this score in different setting has not been
reported.
•Brent AJ, Lakhanpaul M, Thompson M, Collier J, Ray S, Ninis N, et al. Risk score to stratify children with suspected
serious bacterial infection: observational cohort study Arch Dis Child. 2011;96: 361–367.
This is first study in Indonesia
This scoring model has not been tested in limited
health care centre
20
SCREENING TOOL
Sensitivity
Likelihood ratio
Post-test probability
21
This study :
• Sensitivity 58,9% and specificity 86,7%
• PPV 64,2% and NPV 83,8%
• Positive LR 4,42 and negative LR 0,47
• Post test probability 64,23 per 100 (95% CI 54,2-73,1),
• Area under ROC curve 72,8%
Low sensitivity was not good for screening
Positive LR 4,42 ( 95% CI 2,91- 6,72) : small
change from pre-test probability to post-test
probability.
22
………….VALIDITY of SBI score
Other component : post-test probability.
In this study :
post-test probability 64,23%, we can used this score
but it must continue with the other test
23
………….VALIDITAS SKOR IBS
Risk factor Analysis for SBI
Clinical symptoms and signs as predictor of SBI has
been reported by many study with different result.
Hsiao et al16 find age and height of fever were not
significant predictor of SBI. White blood cell count and
CRP were elevated in infant with SBI.
•Hsiao AL, Chen L, Baker MD. Incidence and predictors of serious bacterial infection among 57 to 180
day old infant. Pediatrics journal. 2006; 117:1695-701.
………….Validity of SBI Score
Risk factor analysis for SBI …………..
Trautner et al, child less than 18 years old who come to
emergency department with hyperpirexia , risk for SBI : age < 36
months, chronic illness, diarrhea, fever more than 48 hours, absolute
neutrophil count ≥ x 3 sel/mm3.
Opiyo et al, systematic review, among sick infants aged 0–59
days, the most valuable in identifying infants at risk of severe illness :
history of feeding difficulty, history of convulsions, temperature
axillary ≥3 . °C or
1
Background
the increase of child mortality in developing country,
the high incidence of serious bacterial infection in
children,
the variety of risk factors of serious infections,
current scoring model has not been tested in limited
health care centre.
Craig JC, Williams GJ, Jones M, Codarini M, Macaskill P, Hayen A, et al. The accuracy of clinical symptoms and signs for the
diagnosis of serious bacterial infection in young febrile children: prospective cohort study of 15 781 febrile illnesses. BMJ
2010;340:1-12
Opiyo N, English M. What clinical signs best identify severe illness in young infants aged 0–59 days in developing countries? A
systematic review. Arch Dis Child. 2011;96:1052–59
2
Background……
In clinical practice, discriminating children with SBI
from those with other self limiting infections is
challenging.
A simple, validated clinical tool to risk stratify and
guide further management of children with suspected
SBI would greatly improve their care.
Craig JC, Williams GJ, Jones M, Codarini M, Macaskill P, Hayen A, et al. The accuracy of clinical symptoms and signs for the
diagnosis of serious bacterial infection in young febrile children: prospective cohort study of 15 781 febrile illnesses. BMJ
2010;340:1-12
Opiyo N, English M. What clinical signs best identify severe illness in young infants aged 0–59 days in developing countries? A
systematic review. Arch Dis Child. 2011;96:1052–59
3
Objective.
to know the validity of of Royal College of Paediatrics
and Child Health Score (SBI score) to predict serious
bacterial infection in children with fever and
Validity of SBI score in different cut off point
Validity of SBI score based on age category
to find predictor factors of the serious infection.
4
Method.
Diagnostic study was used to find validity of RCPCH
Score and cohort prospective study to find predictor
factors of the serious infection.
Gold standard was the latest diagnosis noted on
medical record based on ICD-10.
All tests were done blind.
5
Sample Population : febrile children 1 months-12
years old who was come to emergency department and
policlinic Sanglah Hospital that eligible for inclusion
and exclusion criteria.
Convenient sampling
January - December 2014.
6
Inclusion criteria :
1. Febrile children less than 7 days,
2. Come first time for that febrile episode and
accompanied by parents,
3. Parents agree to joint in this study.
Exclusion criteria :
• Febrile children with emergency condition,
• Parent didn’t have hand phone or home
number.
7
8
9
Statistical Methods :
Analysis were performed using computer
Sensitivity, specificity, positive predictive value, negative
predictive value, positive likelihood rasio, negative
likelihood rasio, post test probability, area under ROC curve
were reported
Logistic regression were performed to find predictor factor
for SBI
Ethics approval was granted by the Ethics Comitte (Badan
Litbang FK UNUD/RSUP Sanglah Denpasar).
10
Results
There were 260 subjects. Seven patients of out-patient
department could not be reached so analysis was done
on 253 subjects (97.3%).
There were more male than female with the ratio of
1.14:1.
Age group of >36 months dominated the subject
population (51.4%).
Serious bacterial infection was found on 28.9% subject
with the most diagnosis was pneumonia (19%).
11
12
Table 9. Characteristic of study populations (n =253)
Variable
Age (n, %)
1-36 months
> 36 months
Sex (n, %)
Male
Female
Status of patients (n, %)
Hospitalized
Ambulatory
Laboratory examination
WBC, n = 241 (n, mean)
SBI
Non SBI
CRP, n = 44 (n, mean)
SBI
Non SBI
Procalsitonin, n = 24 (n, mean)
SBI
Non SBI
Blood culture, n = 57 (n, %)
Bacteremia
No growth
123 (48,6)
130 (51,4)
135 (53,4)
118 (46,6)
239 (94,5)
14 (5,5)
72 (16,99 x 103/ul)
169 (7,97 x 103/ul))
33 (31,85 mg/L)
11 (3,77 mg/L)
20 (65,35 ng/ml)
4 (8,5 ng/ml)
15 (26,3)
42 (73,7)
WBC white blood cell; SBI serious bacterial infection; CRP C-reactive protein.
13
Table 10. Distribution of diagnosis
Diagnosis
SBI
Acute Otitis Media
Empiema
Pneumonia
Diarrhea by bacterial infection
Sepsis
Tonsilopharyngitis bacterial
Urinary tract infection
Non SBI
Dengue Shock Syndrome
Dengue Hemorrhagic Fever
Dengue fever
Febrile convulsion
Bronchiolitis
Ensephalitis
Diarrhea by viral infection
Others
n (%)
4 (1,6)
3 (1,2)
48 (19,0)
4 (1,6)
6 (2,4)
3 (1,2)
5(2,0)
22 (8,7)
49 (19,4)
31 (12,3)
16 (6,3)
9 (3,6)
6 (2,4)
5 (2,01)
42 (16,7)
SBI serious bacterial infection
14
Table 11. Validity of SBI score to evaluate serious bacterial infection in febrile children
Diagnosis
SBI score
Total
SBI
Non SBI
SBI
43
24
67
Non SBI
30
156
186
Total
73
180
253
Sensitivity 58,9% (95% CI 47,5-69,5), specificity 86,7% (95% CI 80,9-90,9),
positive predictive value 64,2% (95% CI 54,2-73,1), negative predictive value
83,8% (95% CI 79,7- 87,3), positive likelihood rasio 4,42 (95% CI 2,91-6,72),
negative likelihood rasio 0,47 (95% CI 0,36-0,63), post test probability 64,23
per 100 (95% CI 54,2-73,1), area under ROC curve 72,8% (95% CI 66,6-79,0).
15
Table 12. Diagnostic test of SBI score in different cut off point
Cut off point SBI score to predict SBI
3
95% CI
4
95% CI
5
95% CI
6
95% CI
7
95% CI
Sens
87,7
78,2-93,4
71,2
59,9-80,4
58,9
47,5-69,5
34,2
24,4-45,7
24,7
16,2-35,64
Spec
43,9
36,8-51,2
70,0
62,9-76,2
86,7
80,9-90,9
91,6
86,7-94,9
96,7
92,9-98,5
PPV
38,8
35,2-42,6
49,1
42,5-55,8
64,2
54,2-73,1
62,6
48,5-74,8
75,0
56,1-87,6
NPV
89,8
82,5-94,2
85,7
80,5-89,7
83,8
79,7-87,3
77,4
74,3-80,3
75,9
73,4-78,3
PLR
1,6
1,3-1,8
2,4
1,8-3,1
4,4
2,9-6,7
4,1
2,3-7,3
7,4
3,1-17,9
NLR
0,3
0,2-0,5
0,4
0,3-0,6
0,5
0,4-0,6
0,7
0,6-0,9
0,8
0,7-0,9
Prevalens
28,9
PTP
38,4
35,2-42,6
49,11
42,5-55,8
64,2
54,2-73,1
62,55
48,5-74,8
75,04
56,1-87,6
AUC
65,8
60,5-71,0
70,6
64,4-76,8
72,8
66,6-79,0
63,0
57,2-68,8
60,7
55,5-65,8
28,9
28,9
28,9
28,9
Sens Sensitivity; Spes specificity, PPV positive predictive value; NPV negative predictive value; PLR
positive likelihood rasio; NLR negative likelihood rasio; PTP post test probability; AUC area under ROC
curve
16
Tabel 13. Diagnostic test of SBI score based on age category
Diagnostic test of SBI score based on age
1-36 bulan
95% CI
> 36 bulan
95% CI
Sens (%)
61,40
48,43-72,94
50,00
28,00-72,00
Spec (%)
80,30
69,16-88,11
90,35
83,54-94,53
PPV (%)
72,9
61,48-81,95
42,1
25,8-60,3
NPV (%)
70,7
62,98-77,33
92,8
88,72-95,48
PLR (%)
3,12
1,84-5,29
5,18
2,46-10,92
NLR (%)
0,48
0,34-0,68
0,55
0,34-0,91
Prevalence
46,3
PTP (%)
72,92
61,48-81,95
42,09
25,80-60,30
AUC (%)
70,9
62,9-78,8
70,2
57,6-82,7
12,3
Sens Sensitivity; Spes specificity, PPV positive predictive value; NPV negative predictive value; PLR
positive likelihood rasio; NLR negative likelihood rasio; PTP post test probability; AUC area under
ROC curve
17
Table 14. Univariate Analysis of predictor for serious bacterial infection
No
Variable
SBI
Non SBI
p
N
%
N
%
Age
1-36 months
>36 months
57
16
46,3
12,3
66
114
53,7
87,7
0,001
2
Sex; male
45
33,3
90
66,7
0,093
3
Duration of
(n,median)
73
4,09
180
4,18
0,624**
4
Cough
52
52,0
48
48,0
5
Rhinorrhea
41
48,8
43
6
Breathing difficulty
44
74,6
7
Diarrhea
10
8
Convulsion
9
OR
95%CI
Min
Max
6,2
3,2
11,6
1,6
0,9
2,7
0,001
6,8
3,7
12,5
51,2
0,001
4,1
2,3
7,3
15
25,4
0,001
16,5
8,2
33,6
41,7
14
58,3
0,149
1,9
0,8
4,4
2
6,5
29
93,5
0,003*
6,8
1,6
29,4
Unconsciousness
6
20,0
24
80,0
0,254
1,1
0,9
1,4
10
Dysuria
0
0
2
100,0
1,000*
1,4
1,3
1,5
11
Development delay
4
50,0
4
50,0
0,233*
2,6
0,6
10,5
12
Risk of infection
32
32,3
67
67,7
0,329
1,3
0,8
2,3
13
State variation
Eye closed
23
46,0
27
54,0
0,003
2,6
1,3
4,9
14
Temperature ≥ 37,5
71
35,7
128
64,3
0,001
14,4
3,4
60,9
15
CRT >2 s
12
25,0
36
75,0
0,513
0,8
0,4
1,6
16
Dehydration
12
50,0
12
50,0
0,016
2,8
1,2
6,5
17
Tachypnoea
51
64,6
28
35,4
0,001
12,6
6,6
23,9
18
Hypoxia
30
65,2
16
34,8
0,001
7,2
3,6
14,3
1
CRT Capillary refill time
*Uji Fisher
**Uji Mann-Whitney
fever
18
Table 15. Multivariate Analysis of predictor for serious bacterial infections
Step
Variabel
Step 6
Cough
Breathing difficulty
Diarrhea
Convulsion
Age
Temperature
Hipoxia
Tachypnoea
Constanta
B
OR
P
1,036
0,951
1,285
2,487
0,859
2,055
1,236
1,033
-7,119
2,819
2,589
3,614
12,027
2,360
7,809
3,441
2,810
0,010
0,023
0,064
0,029
0,003
0,051
0,016
0,012
0,026
0,000
95% CI
Min
Max
1,153
6,891
0,945
7,098
1,140 11,455
2,374 60,886
0,997
5,586
1,476 41,305
1,318
8,984
1,135
6,960
19
DISCUSSION
Clinical scoring model to predict SBI in children was less
reported.
Brent et al demonstrates the potential utility of a clinical score
in risk stratifying children with suspected SBI Royal
College of Paediatrics and Child Health score (SBI score)
Validation of this score in different setting has not been
reported.
•Brent AJ, Lakhanpaul M, Thompson M, Collier J, Ray S, Ninis N, et al. Risk score to stratify children with suspected
serious bacterial infection: observational cohort study Arch Dis Child. 2011;96: 361–367.
This is first study in Indonesia
This scoring model has not been tested in limited
health care centre
20
SCREENING TOOL
Sensitivity
Likelihood ratio
Post-test probability
21
This study :
• Sensitivity 58,9% and specificity 86,7%
• PPV 64,2% and NPV 83,8%
• Positive LR 4,42 and negative LR 0,47
• Post test probability 64,23 per 100 (95% CI 54,2-73,1),
• Area under ROC curve 72,8%
Low sensitivity was not good for screening
Positive LR 4,42 ( 95% CI 2,91- 6,72) : small
change from pre-test probability to post-test
probability.
22
………….VALIDITY of SBI score
Other component : post-test probability.
In this study :
post-test probability 64,23%, we can used this score
but it must continue with the other test
23
………….VALIDITAS SKOR IBS
Risk factor Analysis for SBI
Clinical symptoms and signs as predictor of SBI has
been reported by many study with different result.
Hsiao et al16 find age and height of fever were not
significant predictor of SBI. White blood cell count and
CRP were elevated in infant with SBI.
•Hsiao AL, Chen L, Baker MD. Incidence and predictors of serious bacterial infection among 57 to 180
day old infant. Pediatrics journal. 2006; 117:1695-701.
………….Validity of SBI Score
Risk factor analysis for SBI …………..
Trautner et al, child less than 18 years old who come to
emergency department with hyperpirexia , risk for SBI : age < 36
months, chronic illness, diarrhea, fever more than 48 hours, absolute
neutrophil count ≥ x 3 sel/mm3.
Opiyo et al, systematic review, among sick infants aged 0–59
days, the most valuable in identifying infants at risk of severe illness :
history of feeding difficulty, history of convulsions, temperature
axillary ≥3 . °C or