Table 1 Clinical and laboratory prediction rules for management of acute febrile illnesses in childrena
Name of Prediction Rule | Age Group | Predictors | Derivation study | ||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
All serious infections | |||||||||||||
Yale Observation Scale | 0-24 m | Quality of Cry | Reaction to parents’ stimulation | State Variation | Color | Hydration | Response to social overtures | McCarthy et al. [39] | |||||
Strong OR not crying(1) | Cries briefly (1) | Stays awake (1) | Pink (1) | Skin normal (1) | Smiles OR Alert (1) | ||||||||
Whimpering (3) | Cries on/off (3) | Awakes with stimulation (3) | Pale extremities (3) | Dry mouth (3) | Brief smile OR alerts briefly (3) | ||||||||
Weak (5) | Continual cry (5) | Falls to sleep (5) | Pale OR cyanotic (5) | Skin doughy (5) | No smile OR face anxious (5) | ||||||||
Sum of all six feature values (cut-offs used in literature: 8, 9 or 10) | |||||||||||||
Five Stage Decision Tree | 0–16 y | Clinician instinct that something is wrong | Dyspnea | Temperature > 39.95 °C | Diarrhea | Age 15-25 m | Van den Bruel et al. [17] | ||||||
No | 0 | No or unknown | 0 | No | 0 | No or unknown | 0 | No or unknown | 0 | ||||
Yes or unknown | 1 | Yes | 1 | Yes | 1 | Yes | 1 | Yes | 1 | ||||
If yes to any of these five features | |||||||||||||
Bleeker | 0-36 m | Duration fever Days (points) | H/o vomiting | Ill appearance | Chest wall retractions+ tachypnea | Poor peripheral circulation | WBC | CRP (mg/l) | Urine WBC | Bleeker et al. [18] | |||
0.5 (0), 1(2), 1.5 (4),2–2.5(5), 3–3.5(6), 4–4.5(7), 5–6(8), 6.5–8.5(9), ≥ 9(10) | Y = 5 | Y = 4 | Y = 12 | Y = 7 | < 10(0), 10–19(2), 20–29(4), 30–39(6), ≥ 40(8) | Divide value by 10 and round to lower integer, max. = 16 points | ≥ 70 WBC/μl =9 | ||||||
Total points, described cutoffs: clinical: 10, lab: 8 | |||||||||||||
Thayyil | 1-36 m | PCT (ng/ml) | CRP (mg/l) | WBC | Thayyil [19] | ||||||||
> 2 | > 50 | > 15 | |||||||||||
Cutoff: All positive | |||||||||||||
Lab Score | 7d-36 m | PCT (ng/ml) | CRP (mg/l) | Urine Dipstick | Galetto-Lacour [20] | ||||||||
< 0.5 (0), ≥0.5 (2), ≥2 (4) | < 40 (0), 40–99 (2), ≥100 (4) | Positive leucocyte or nitrite | |||||||||||
Cutoff: 3 | |||||||||||||
AUS fever model | 0–5 y | General appearance, cough, temperature, breathing difficulty, abnormal chest sounds, chronic disease, capillary refill time, urinary symptoms, respiratory rate, chest crackles, pneumococcal vaccine, heart rate, felt hot, meningococcal vaccine, infectious contacts, crying, fluid intake, respiratory symptoms, diarrhea, bulging fontanel, male, focal bacterial infection, abnormal ear, nose, and throat signs, age rash, stridor, wheeze | Craig et al. [21] | ||||||||||
Model risk estimate | |||||||||||||
SBI risk score | 1 m-15y | Developmental delay | Infection risk factor | State variation | T (°C) | CRT | Hydration | Tachypneab | Hypoxia | Brent et al. [22] | |||
No (0) Yes (4) | No (0), Yes (2) | Eyes open (0) Eyes close briefly (1) Falls asleep (2) | < 37.5 (0), 37.5–38.3 (1) ≥38.4 (2) | < 2 (0) ≥2 (2) | Well hydrated (0) Dry mucous membranes (2) Reduced skin turgor (4) | No (0) Yes (1) | No (0) Mild (1) Severe (2) | ||||||
Rotterdam Fever model | 1 m-16y | Age < 1, Sex, Duration of Fever, Height of Fever, Tachypnea, Tachycardia, SaO2 < 94%, CRT > 3 s, Chest Wall retraction, Ill-appearance, CRP | Nijman et al. [23] | ||||||||||
Model risk estimate | |||||||||||||
Pneumonia | |||||||||||||
Pneumonia Rule n°1 | 0–16 y | Parental concern illness is different | Shortness of breath | Van den Bruel et al. [17] | |||||||||
Values | If yes to any of these two features | ||||||||||||
Pneumonia Rule n°2 | 0-21y | SaO2 | Triage T | Wheeze | Decreased breath sounds | Focal rales | Chest pain | History of fever | Neuman et al. [24] | ||||
Values | Classification of Regression Tree/ clinical model | ||||||||||||
Pneumonia Rule n°3 | 1-16y | Grunting | Cough | Rales | Decreased breath sound | Vomiting | Bilkis et al. [25] | ||||||
Model risk estimate | |||||||||||||