OBJECTIVE: To collate all available evidence on the diagnostic value of laboratory tests for the diagnosis of serious infections in febrile children in ambulatory settings.DESIGN: Systematic review.DATA SOURCES: Electronic databases, reference tracking, and consultation with experts.STUDY SELECTION: Studies were selected on six criteria: design (studies of diagnostic accuracy or deriving prediction rules), participants (otherwise healthy children and adolescents aged 1 month to 18 years), setting (first contact ambulatory care), outcome (serious infection), features assessed (in first contact care), and data reported (sufficient to construct a 2×2 table).DATA EXTRACTION: Quality assessment was based on the quality assessment tool of diagnostic accuracy studies (QUADAS) criteria. Meta-analyses were done using the bivariate random effects method and hierarchical summary receiver operating characteristic curves for studies with multiple thresholds.DATA SYNTHESIS: None of the 14 studies identified were of high methodological quality and all were carried out in an emergency department or paediatric assessment unit. The prevalence of serious infections ranged from 4.5% to 29.3%. Tests were carried out for C reactive protein (five studies), procalcitonin (three), erythrocyte sedimentation rate (one), interleukins (two), white blood cell count (seven), absolute neutrophil count (two), band count (three), and left shift (one). The tests providing most diagnostic value were C reactive protein and procalcitonin. Bivariate random effects meta-analysis (five studies, 1379 children) for C reactive protein yielded a pooled positive likelihood ratio of 3.15 (95% confidence interval 2.67 to 3.71) and a pooled negative likelihood ratio of 0.33 (0.22 to 0.49). To rule in serious infection, cut-off levels of 2 ng/mL for procalcitonin (two studies, positive likelihood ratio 13.7, 7.4 to 25.3 and 3.6, 1.4 to 8.9) and 80 mg/L for C reactive protein (one study, positive likelihood ratio 8.4, 5.1 to 14.1) are recommended; lower cut-off values of 0.5 ng/mL for procalcitonin or 20 mg/L for C reactive protein are necessary to rule out serious infection. White blood cell indicators are less valuable than inflammatory markers for ruling in serious infection (positive likelihood ratio 0.87-2.43), and have no value for ruling out serious infection (negative likelihood ratio 0.61-1.14). The best performing clinical decision rule (recently validated in an independent dataset) combines testing for C reactive protein, procalcitonin, and urinalysis and has a positive likelihood ratio of 4.92 (3.26 to 7.43) and a negative likelihood ratio of 0.07 (0.02 to 0.27).CONCLUSION: Measuring inflammatory markers in an emergency department setting can be diagnostically useful, pandora Charms Nz but clinicians should apply different cut-off values depending on whether they are trying to rule in or rule out serious infection. Measuring white blood cell pandora Charms count is less useful for ruling in serious infection and not useful for ruling out serious infection. More rigorous studies are needed, including pandora Jewelry Nz studies in primary care, to assess the value of laboratory tests alongside clinical diagnostic measurements, including vital signs.Comment inHow useful are laboratory tests in diagnosing serious infections in febrile children? [BMJ. 2011]How useful are laboratory tests in diagnosing serious infections in febrile children?Aronoff SC. BMJ. 2011 Jun 8; 342:d2782. Epub 2011 Jun Pandora Nz 8.[In Process Citation]. [Praxis (Bern 1994). 2011][In Process Citation].Steurer J. Praxis (Bern 1994). 2011 Oct 5; 100(20):1255-6. Is there a blood test that can rule out serious bacterial infection in children? [Ann Emerg Med. 2012]Is there a blood test that can rule out serious bacterial infection in children?Hom J. Ann Emerg Med. 2012 Jul; 60(1):92-3. Epub 2011 Dec 10.


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