559 - Predictors of invasive bacterial infections in febrile children 3-36 months old presenting to the emergency department.

Publication Number: 2544.559

Jemima Degamo, Albany Medical College, San Diego, CA, United States; Naziba Nuha, Albany Medical College, Albany, NY, United States; Christopher Woll, Albany Medical Center, Albany, NY, United States; Kanchan S. Railkar, Albany Medical Center, Albany, NY, United States

Background: Fever accounts for up to 40% of visits to the pediatric emergency department (ED). When evaluating and treating febrile children in the ED, providers must consider various factors and their impact on the patient's risk profile for invasive bacterial infections (IBI).

Objective: This study aims to determine the diagnostic abilities of various patient characteristics in predicting IBIs in well-appearing pediatric patients presenting to the ED with fever.

Design/Methods: This is a retrospective cross-sectional study conducted between 2019-2023 at a single, urban tertiary care pediatric emergency department. Patients were included if they were between 61 days and ≤3 years old presenting with a chief complaint of fever. This research is classified as exempt by the Institutional Review Board. Patients were excluded if they received antibiotics within 3 days of presentation, underwent surgical procedures within 2 weeks of presentation, had an emergency department visit for febrile illness within 2 weeks prior to the study visit, were transferred from another institution, or were ill-appearing. IBI was defined as bacteremia, bacterial meningitis, septic arthritis, osteomyelitis, pneumonia, deep neck space infection, mastoiditis, or orbital cellulitis. Prevalence of IBI was described and compared by age, presence of chronic medical condition, gestational age, sex, and vaccination status. STATA statistical software was used to calculate the chi square and diagnostic testing characteristics with 95% confidence intervals (CIs).

Results: Of 1196 patients screened, 933 patients were included in the study. Of those, 485 (52%) were male, 136 (15%) had chronic medical conditions (CMC), 85 (9%) were pre-term, 37 (4%) were under-vaccinated. The total prevalence of IBI amongst our study cohort was 0.64%. Absence of CMC, preterm gestation and under-vaccination had independently statistically significant negative likelihood ratios when evaluating for IBI in well appearing febrile pediatric patients in the ED.

Conclusion(s): The prevalence of IBI in well appearing pediatric patients is exceedingly rare. The absence of under-vaccinated status, CMC, and pre-maturity can help rule out IBI in well-appearing febrile pediatric patients presenting to the emergency department.

Table 1: Demographic and Clinical characteristics of febrile children aged 3-36months presenting to the pediatric ED (n=933)


Table 2: Bivariate analysis of predictor variables as they relate to the presence of invasive bacterial infections.


Table 3: Diagnostic Testing Characteristics of Predictor Variables
Sensitivity, Specificity, Positive Predictive Value (PPV), Negative Predictor Value (NPV), Positive Likelihood Ratio (LR+), and Negative Likelihood Ratio (LR-) for patient characteristics in identifying IBIs. Absence of CMC, prematurity, and under vaccination demonstrates strong negative likelihood ratios, supporting their utility in ruling out IBI in well- appearing febrile children.