Reliability of observation variables in distinguishing infectious outcome of febrile young infants

W. A. Bonadio, H. Hennes, D. Smith, R. Ruffing, M. Melzer-Lange, P. Lye, D. Isaacman

Research output: Contribution to journalArticlepeer-review

51 Scopus citations

Abstract

We propsectively evaluated 7 observation variables (level of activity, level of alertness, respiratory status/effort, peripheral perfusion, muscle tone, affect, feeding pattern) which qualify patient clinical appearance in order to determine reliability in distinguishing the infectious outcome of 233 febrile infants ages 0 to 8 weeks. Each variable was graded either 1, 3, or 5, with a higher score indicative of a greater degree of compromise. All infants received physical examination and sepsis evaluation (lumbar puncture, complete blood count/blood culture, urinalysis/urine culture).The 3 outcome groups compared were 29 cases of serious bacterial infections, (+SBI; 10 with bacterial meningitis, 12 with bacteremia, 7 with urinary tract infection), 45 cases of aseptic meningitis (AM) and 159 cases culture-negative with normal cerebrospinal fluid (CN-NCSF). The mean score for each of the 7 variables was significantly greater in the +SBI group compared with both the AM and CN-NCSF groups (p<0.05), whereas there was no significant difference in mean score for each of the 7 variables between the AM and CN-NCSF groups. Stepwise discriminant analysis identified 3 variables that best distinguished outcome: Affect; respiratory status/effort; and peripheral perfusion, which constituted the Young Infant Observation Scale. The mean total Young Infant Observation Scale score generated from assessing these 3 variables was significantly greater (p=0.0001) in the +SBI, group (9) compared with both the AM (5) and CN-NCSF (5) groups. A total Young Infant Observation Scale score ≥7 had a sensitivity of 76%, specificity of 75% and negative-predictive value of 96% for outcome of +SBI.

Original languageEnglish (US)
Pages (from-to)111-114
Number of pages4
JournalPediatric Infectious Disease Journal
Volume12
Issue number2
DOIs
StatePublished - Feb 1993

Keywords

  • Behavioral parameters
  • Febrile young infant
  • Observation scale
  • Patient clinical appearance
  • Serious bacterial infections

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Microbiology (medical)
  • Infectious Diseases

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