This article is more than 5 years old. Information may no longer be current.
‘Lab-score’ appeared unreliable for predicting invasive bacterial infection
Use of “lab-score” alone would have resulted in misdiagnosis of 30% of infants with an invasive bacterial infection, according to study results published online.
Silvia Bressan, MD, of the University of Padova in Italy, and colleagues published the results of a study that evaluated the diagnostic accuracy of the lab-score. The study was conducted in seven pediatric EDs in Italy and Spain. The goal of the study was to assess the accuracy of the lab-score in identifying serious bacterial infections and invasive bacterial infections in well-appearing febrile infants with unknown source of fever.
According to their results 28.3% of the 1,012 included infants had a serious bacterial infection, and a lab-score of at least three showed a positive likelihood ratio of 10.2 and a negative likelihood ratio of 0.5. For the 2% of the 1,098 infants with an invasive bacterial infection, a lab-score of at least three showed a lower positive likelihood ratio of 4.3 and a negative likelihood ratio of 0.4.
The researchers concluded that the lab-score “seems a more useful tool for ruling in, rather than ruling out, [serious bacterial infections].” In addition, “Its accuracy for [invasive bacterial infection] prediction is unsatisfactory.”
As acknowledged by the researchers, some study limitations should be noted, specifically that the retrospective design may have allowed the possible inclusion of not completely well-appearing infants. Bressan told Infectious Diseases in Children that urine culture collection methods also varied according to study centers. Despite previous encouraging data on lab-score accuracy in identifying severe bacterial infections in febrile children aged younger than 36 months, the study by Bressan and colleagues does not support its usefulness for well-appearing infants aged younger than 3 months who have fever without source.
Disclosure: The researchers report no relevant financial disclosures.
Collapse