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Table 1 Clinical and laboratory prediction rules for management of acute febrile illnesses in childrena

From: Performance of prediction rules and guidelines in detecting serious bacterial infections among Tanzanian febrile children

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  
  1. bpm Beats per minute, CRT Capillary refill time, CRP C-reactive protein, h/o History of, m Months, SaO2 Oxygen saturation, PCT Procalcitonin, RR Respiratory rate, T Body temperature, Y Yes, y Years, WBC White blood cell count
  2. aModified and appended from Verbakel et al. [33]
  3. bAdvanced pediatric life support cutoff