Determinants of infection for antibiotic initiation at pediatric emergency admission: A prospective observational study.

BACKGROUND

Due to non-specific and overlapping features, particularly in infants, and a lack of awareness of important signs and symptoms, early diagnosis of sepsis is difficult.

AIM: To identify the determinants for bacterial infection based on clinical evidence and point-of-care (POC) investigations in children at admission to a pediatric emergency medicine (PEM) unit.

METHODS

This prospective observational study was conducted in a PEM unit of a tertiary care hospital in Central India. A scoring system based on these determinants for initiation of antibiotics in the golden hour (i.e. the first 60 minutes) was developed, termed as the Children's Antibiotic Requirement Evaluation Score (CARES) Index.

RESULTS

Out of a total of 1419 children presenting to the PEM, 802 children were enrolled. The best predictors of infection were found to be abnormal color, fever, features of fluid overload, altered sensorium, cellulitis, use of antibiotics, and C-reactive protein. These parameters were amalgamated to form the CARES Index, which showed moderate accuracy for determinants of infection for initiation of antibiotics in a pediatric emergency. Among the POC investigations, the sensitivity of the erythrocyte sedimentation rate (80.00%) was maximum, while specificity was highest for procalcitonin (75.31%).

CONCLUSION

We highlighted the association of clinical parameters, symptoms, and POC investigations in pediatric bacterial infections. Some parameters emerged as strong predictors of sepsis, and no single factor was sufficient for a definitive diagnosis.