{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,5]],"date-time":"2026-11-05T22:36:23Z","timestamp":1793918183993,"version":"4.8.0"},"reference-count":41,"publisher":"American Academy of Pediatrics (AAP)","issue":"2","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2016,8,1]]},"abstract":"<jats:sec>\n                    <jats:title>BACKGROUND:<\/jats:title>\n                    <jats:p>A sequential approach to young febrile infants on the basis of clinical and laboratory parameters, including procalcitonin, was recently described as an accurate tool in identifying patients at risk for invasive bacterial infection (IBI). Our aim was to prospectively validate the Step-by-Step approach and compare it with the Rochester criteria and the Lab-score.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS:<\/jats:title>\n                    <jats:p>Prospective study including infants \u226490 days with fever without source presenting in 11 European pediatric emergency departments between September 2012 and August 2014. The accuracy of the Step-by-Step approach, the Rochester criteria, and the Lab-score in identifying patients at low risk of IBI (isolation of a bacterial pathogen in a blood or cerebrospinal fluid culture) was compared.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS:<\/jats:title>\n                    <jats:p>Eighty-seven of 2185 infants (4.0%) were diagnosed with an IBI. The prevalence of IBI was significantly higher in infants classified as high risk or intermediate risk according to the Step by Step than in low risk patients. Sensitivity and negative predictive value for ruling out an IBI were 92.0% and 99.3% for the Step by Step, 81.6% and 98.3% for the Rochester criteria, and 59.8% and 98.1% for the Lab-score. Seven infants with an IBI were misclassified by the Step by Step, 16 by Rochester criteria, and 35 by the Lab-score.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSIONS:<\/jats:title>\n                    <jats:p>We validated the Step by Step as a valuable tool for the management of infants with fever without source in the emergency department and confirmed its superior accuracy in identifying patients at low risk of IBI, compared with the Rochester criteria and the Lab-score.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1542\/peds.2015-4381","type":"journal-article","created":{"date-parts":[[2016,7,5]],"date-time":"2016-07-05T05:07:25Z","timestamp":1467695245000},"source":"Crossref","is-referenced-by-count":318,"title":["Validation of the \u201cStep-by-Step\u201d Approach in the Management of Young Febrile Infants"],"prefix":"10.1542","volume":"138","author":[{"given":"Borja","family":"Gomez","sequence":"first","affiliation":[{"name":"Pediatric Emergency Department, Cruces University Hospital, Bilbao, Spain;"},{"name":"University of the Basque Country, Bilbao, Spain;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Santiago","family":"Mintegi","sequence":"additional","affiliation":[{"name":"Pediatric Emergency Department, Cruces University Hospital, Bilbao, Spain;"},{"name":"University of the Basque Country, Bilbao, Spain;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Silvia","family":"Bressan","sequence":"additional","affiliation":[{"name":"Pediatric Emergency Unit - Department of Woman's and Child Health, University of Padova, Italy;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Liviana","family":"Da Dalt","sequence":"additional","affiliation":[{"name":"Ca\u2019Foncello Hospital, Treviso, Italy; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alain","family":"Gervaix","sequence":"additional","affiliation":[{"name":"Pediatric Emergency Division, Geneva University Hospitals and University of Geneva, Geneva, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laurence","family":"Lacroix","sequence":"additional","affiliation":[{"name":"Pediatric Emergency Division, Geneva University Hospitals and University of Geneva, Geneva, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"on behalf of the European Group for Validation of the Step-by-Step Approach","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"417","published-online":{"date-parts":[[2016,8,1]]},"reference":[{"issue":"3","key":"2021120904513055300_B1","doi-asserted-by":"crossref","first-page":"390","DOI":"10.1542\/peds.94.3.390","article-title":"Febrile infants at low risk for serious bacterial 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Management of infants and young children with fever without source.","volume-title":"Pediatr Ann","author":"Baraff","year":"2008"},{"key":"2021120904513055300_B19","unstructured":"Cincinnati Children\u2019s Hospital Medical Center . Evidence-based care guideline for fever of uncertain source in infants 60 days of age or less. October 27, 2010. Available at: www.cincinnatichildrens.org\/workarea\/linkit.aspx?linkidentifier=id&itemid=87913&libid=87601. Accessed May 24, 2016"},{"key":"2021120904513055300_B20","unstructured":"National Institute for Health and Care Excellence . 2013. Feverish illness in children. Assessment and initial management in children younger than 5 years. London: National Institute for Health and Care Excellence. Available at: www.nice.org.uk\/guidance\/cg160. 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