Validating a decision tree for serious infection : diagnostic accuracy in acutely ill children in ambulatory care
Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions..
OBJECTIVE: Acute infection is the most common presentation of children in primary care with only few having a serious infection (eg, sepsis, meningitis, pneumonia). To avoid complications or death, early recognition and adequate referral are essential. Clinical prediction rules have the potential to improve diagnostic decision-making for rare but serious conditions. In this study, we aimed to validate a recently developed decision tree in a new but similar population.
DESIGN: Diagnostic accuracy study validating a clinical prediction rule.
SETTING AND PARTICIPANTS: Acutely ill children presenting to ambulatory care in Flanders, Belgium, consisting of general practice and paediatric assessment in outpatient clinics or the emergency department.
INTERVENTION: Physicians were asked to score the decision tree in every child.
PRIMARY OUTCOME MEASURES: The outcome of interest was hospital admission for at least 24 h with a serious infection within 5 days after initial presentation. We report the diagnostic accuracy of the decision tree in sensitivity, specificity, likelihood ratios and predictive values.
RESULTS: In total, 8962 acute illness episodes were included, of which 283 lead to admission to hospital with a serious infection. Sensitivity of the decision tree was 100% (95% CI 71.5% to 100%) at a specificity of 83.6% (95% CI 82.3% to 84.9%) in the general practitioner setting with 17% of children testing positive. In the paediatric outpatient and emergency department setting, sensitivities were below 92%, with specificities below 44.8%.
CONCLUSIONS: In an independent validation cohort, this clinical prediction rule has shown to be extremely sensitive to identify children at risk of hospital admission for a serious infection in general practice, making it suitable for ruling out.
TRIAL REGISTRATION NUMBER: NCT02024282.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2015 |
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| Erschienen: |
2015 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:5 |
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| Enthalten in: |
BMJ open - 5(2015), 8 vom: 07. Aug., Seite e008657 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Verbakel, Jan Y [VerfasserIn] |
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| Links: |
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| Themen: |
ACCIDENT & EMERGENCY MEDICINE |
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| Anmerkungen: |
Date Completed 12.05.2016 Date Revised 10.12.2019 published: Electronic ClinicalTrials.gov: NCT02024282 Citation Status MEDLINE |
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| doi: |
10.1136/bmjopen-2015-008657 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
NLM251650464 |
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| 100 | 1 | |a Verbakel, Jan Y |e verfasserin |4 aut | |
| 245 | 1 | 0 | |a Validating a decision tree for serious infection |b diagnostic accuracy in acutely ill children in ambulatory care |
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| 500 | |a published: Electronic | ||
| 500 | |a ClinicalTrials.gov: NCT02024282 | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions. | ||
| 520 | |a OBJECTIVE: Acute infection is the most common presentation of children in primary care with only few having a serious infection (eg, sepsis, meningitis, pneumonia). To avoid complications or death, early recognition and adequate referral are essential. Clinical prediction rules have the potential to improve diagnostic decision-making for rare but serious conditions. In this study, we aimed to validate a recently developed decision tree in a new but similar population | ||
| 520 | |a DESIGN: Diagnostic accuracy study validating a clinical prediction rule | ||
| 520 | |a SETTING AND PARTICIPANTS: Acutely ill children presenting to ambulatory care in Flanders, Belgium, consisting of general practice and paediatric assessment in outpatient clinics or the emergency department | ||
| 520 | |a INTERVENTION: Physicians were asked to score the decision tree in every child | ||
| 520 | |a PRIMARY OUTCOME MEASURES: The outcome of interest was hospital admission for at least 24 h with a serious infection within 5 days after initial presentation. We report the diagnostic accuracy of the decision tree in sensitivity, specificity, likelihood ratios and predictive values | ||
| 520 | |a RESULTS: In total, 8962 acute illness episodes were included, of which 283 lead to admission to hospital with a serious infection. Sensitivity of the decision tree was 100% (95% CI 71.5% to 100%) at a specificity of 83.6% (95% CI 82.3% to 84.9%) in the general practitioner setting with 17% of children testing positive. In the paediatric outpatient and emergency department setting, sensitivities were below 92%, with specificities below 44.8% | ||
| 520 | |a CONCLUSIONS: In an independent validation cohort, this clinical prediction rule has shown to be extremely sensitive to identify children at risk of hospital admission for a serious infection in general practice, making it suitable for ruling out | ||
| 520 | |a TRIAL REGISTRATION NUMBER: NCT02024282 | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a Multicenter Study | |
| 650 | 4 | |a Research Support, Non-U.S. Gov't | |
| 650 | 4 | |a Validation Study | |
| 650 | 4 | |a ACCIDENT & EMERGENCY MEDICINE | |
| 650 | 4 | |a EPIDEMIOLOGY | |
| 650 | 4 | |a PRIMARY CARE | |
| 700 | 1 | |a Lemiengre, Marieke B |e verfasserin |4 aut | |
| 700 | 1 | |a De Burghgraeve, Tine |e verfasserin |4 aut | |
| 700 | 1 | |a De Sutter, An |e verfasserin |4 aut | |
| 700 | 1 | |a Aertgeerts, Bert |e verfasserin |4 aut | |
| 700 | 1 | |a Bullens, Dominique M A |e verfasserin |4 aut | |
| 700 | 1 | |a Shinkins, Bethany |e verfasserin |4 aut | |
| 700 | 1 | |a Van den Bruel, Ann |e verfasserin |4 aut | |
| 700 | 1 | |a Buntinx, Frank |e verfasserin |4 aut | |
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