{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,19]],"date-time":"2026-09-19T18:00:27Z","timestamp":1789840827883,"version":"4.0.1"},"reference-count":21,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"10","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Pediatr Emer Care"],"published-print":{"date-parts":[[2016,10]]},"abstract":"<jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>The aim of this study was to analyze the usefulness of physical examination, C-reactive protein (CRP), procalcitonin (PCT), white blood cell (WBC) count, and absolute neutrophils counts (ANCs) for the diagnosis of invasive bacterial infections (IBIs) and potentially serious bacterial infections in infants younger than the age of 3 months presenting with fever without source (FWS) to the emergency department (ED).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A descriptive retrospective study that includes all infants aged younger than 3 months who presented with FWS to the ED between July 2008 and January 2012. We evaluated diagnostic performance for each test by receiver operating characteristic curve analysis. Sensitivity, specificity, positive likelihood ratio, and negative likelihood ratio were also calculated.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Three hundred eighteen patients met the inclusion criteria. Eleven bacteremia (3.5%) and 76 urinary tract infections (23.9%) were diagnosed. To detect IBI, the areas under the curve for the different tests were as follows: PCT, 0.77 (95% confidence interval [CI], 0.57\u20130.96); CRP, 0.54 (95% CI, 0.36\u20130.73); ANC, 0.53 (95% CI, 0.34\u20130.71); and WBC, 0.42 (0.24\u20130.61). To detect potentially serious bacterial infections, the areas under the curve were as follows: PCT, 0.66 (95% CI, 0.59\u20130.74); CRP, 0.68 (0.60\u20130.76); ANC, 0.64 (0.56\u20130.71); and WBC, 0.66 (0.58\u20130.72).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Procalcitonin is better than CRP, WBC, and ANC to confirm or dismiss the presence of an IBI in infants aged younger than 3 months presenting with FWS to the ED. However, it could not identify almost 30% of infants with IBI. Most patients diagnosed with IBI (10 of 11) presented abnormal values in at least one of the analytical parameters and\/or physical appearance. Four of 5 patients with IBI and well appearing presented abnormal results in at least one of the analytical parameters. Therefore, the development of tools combining different tests including the new biomarkers could increase the reliability of the tests for the diagnosis of IBI in these patients.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1097\/pec.0000000000000401","type":"journal-article","created":{"date-parts":[[2015,3,29]],"date-time":"2015-03-29T02:59:28Z","timestamp":1427597968000},"page":"664-668","source":"Crossref","is-referenced-by-count":40,"title":["Lack of Accuracy of Biomarkers and Physical Examination to Detect Bacterial Infection in Febrile Infants"],"prefix":"10.1097","volume":"32","author":[{"given":"Marta Germ\u00e1n","family":"D\u00edaz","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rosa Pavo","family":"Garc\u00eda","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel Bl\u00e1zquez","family":"Gamero","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M. Isabel","family":"Gonz\u00e1lez-Tom\u00e9","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pilar Cedena","family":"Romero","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Milagros Mar\u00edn","family":"Ferrer","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jes\u00fas Ruiz","family":"Contreras","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"bib1-20231023","doi-asserted-by":"crossref","first-page":"5","DOI":"10.1542\/peds.90.1.5","article-title":"Spectrum and frequency of pediatric illness presenting to a general community hospital emergency department","volume":"90","year":"1992","journal-title":"Pediatrics"},{"key":"bib2-20231023","doi-asserted-by":"crossref","first-page":"161","DOI":"10.1179\/acb.2006.027","article-title":"Spectrum and frequency of illness presenting to a pediatric emergency department","volume":"61","year":"2006","journal-title":"Acta Clin Belg"},{"key":"bib3-20231023","doi-asserted-by":"crossref","first-page":"602","DOI":"10.1067\/mem.2000.110820","article-title":"Management of fever without source in infants and children","volume":"36","year":"2000","journal-title":"Ann Emerg Med"},{"key":"bib4-20231023","doi-asserted-by":"crossref","first-page":"1226","DOI":"10.1111\/j.1651-2227.2001.tb01566.x","article-title":"Predicting serious bacterial infection in children with fever without apparent source","volume":"90","year":"2001","journal-title":"Acta Paediatr"},{"key":"bib5-20231023","doi-asserted-by":"crossref","first-page":"533","DOI":"10.1136\/adc.2005.093450","article-title":"How useful is C-reactive protein in detecting occult bacterial infection in young children with fever without apparent focus?","volume":"91","year":"2006","journal-title":"Arch Dis Child"},{"key":"bib6-20231023","doi-asserted-by":"crossref","first-page":"478","DOI":"10.1177\/000992289103000803","article-title":"Relationship of fever magnitude to rate of serious bacterial infections in infants aged 4-8 weeks","volume":"30","year":"1991","journal-title":"Clin Pediatr (Phila)"},{"key":"bib7-20231023","doi-asserted-by":"crossref","first-page":"802","DOI":"10.1542\/peds.70.5.802","article-title":"Observation scale to identify serious illness in febrile children","volume":"70","year":"1982","journal-title":"Pediatrics"},{"key":"bib8-20231023","doi-asserted-by":"crossref","first-page":"167","DOI":"10.1542\/peds.76.2.167","article-title":"Predictive value of abnormal physical examination findings in ill-appearing and well-appearing febrile children","volume":"76","year":"1985","journal-title":"Pediatrics"},{"key":"bib9-20231023","doi-asserted-by":"crossref","first-page":"1040","DOI":"10.1542\/peds.85.6.1040","article-title":"Failure of infant observation scale in detecting serious illness in febrile, 4 to 8 week-old infants","volume":"85","year":"1990","journal-title":"Pediatrics"},{"key":"bib10-20231023","doi-asserted-by":"crossref","first-page":"1437","DOI":"10.1056\/NEJM199311113292001","article-title":"Outpatient management without antibiotics of fever in selected infants","volume":"329","year":"1993","journal-title":"N Engl J Med"},{"key":"bib11-20231023","doi-asserted-by":"crossref","first-page":"22","DOI":"10.1016\/S0022-3476(05)80591-8","article-title":"Outpatient treatment of febrile infants 28 to 89 days of age with intramuscular administration of ceftriaxone","volume":"120","year":"1992","journal-title":"J Pediatr"},{"key":"bib12-20231023","doi-asserted-by":"crossref","first-page":"390","DOI":"10.1542\/peds.94.3.390","article-title":"Febrile infants at low risk for serious bacterial infection\u2014an appraisal of the Rochester criteria and implications for management. 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