Comparison of preoperative diagnostic performance between dual-energy CT, conventional CT, and MRI in endometrial cancer.
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Mahajan Prashant, VanBuren John M, Tzimenatos Leah, Cruz Andrea T, Vitale Melissa, Powell Elizabeth C, Leetch Aaron N, Pickett Michelle L, Brayer Anne, Nigrovic Lise E, Dayan Peter S, Atabaki Shireen M, Ruddy Richard M, Rogers Alexander J, Greenberg Richard, Alpern Elizabeth R, Tunik Michael G, Saunders Mary, Muenzer Jared, Levine Deborah A, Hoyle John D, Lillis Kathleen Grisanti, Gattu Rajender, Crain Ellen F, Borgialli Dominic, Bonsu Bema, Blumberg Stephen, Anders Jennifer, Roosevelt Genie, Browne Lorin R, Cohen Daniel M, Linakis James G, Jaffe David M, Bennett Jonathan E, Schnadower David, Park Grace, Mistry Rakesh D, Glissmeyer Eric W, Cator Allison, Bogie Amanda, Quayle Kimberly S, Ellison Angela, Balamuth Fran, Richards Rachel, Ramilo Octavio, Kuppermann Nathan, Pediatric Emergency Care Applied Research Network (PECARN)
Аннотация
OBJECTIVE: To determine the prevalence of bacteremia and/or bacterial meningitis in febrile infants ≤60 days of age with positive urinalysis (UA) results.
METHODS: Secondary analysis of a prospective observational study of noncritical febrile infants ≤60 days between 2011 and 2019 conducted in the Pediatric Emergency Care Applied Research Network emergency departments. Participants had temperatures ≥38°C and were evaluated with blood cultures and had UAs available for analysis. We report the prevalence of bacteremia and bacterial meningitis in those with and without positive UA results.
RESULTS: Among 7180 infants, 1090 (15.2%) had positive UA results. The risk of bacteremia was higher in those with positive versus negative UA results (63/1090 [5.8%] vs 69/6090 [1.1%], difference 4.7% [3.3% to 6.1%]). There was no difference in the prevalence of bacterial meningitis in infants ≤28 days of age with positive versus negative UA results (∼1% in both groups). However, among 697 infants aged 29 to 60 days with positive UA results, there were no cases of bacterial meningitis in comparison to 9 of 4153 with negative UA results (0.2%, difference -0.2% [-0.4% to -0.1%]). In addition, there were no cases of bacteremia and/or bacterial meningitis in the 148 infants ≤60 days of age with positive UA results who had the Pediatric Emergency Care Applied Research Network low-risk blood thresholds of absolute neutrophil count <4 × 103 cells/mm3 and procalcitonin <0.5 ng/mL.
CONCLUSIONS: Among noncritical febrile infants ≤60 days of age with positive UA results, there were no cases of bacterial meningitis in those aged 29 to 60 days and no cases of bacteremia and/or bacterial meningitis in any low-risk infants based on low-risk blood thresholds in both months of life. These findings can guide lumbar puncture use and other clinical decision making.