External validation of a multivariable prediction model for identification of pneumonia and other serious bacterial infections in febrile immunocompromised children.
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Martin Alexander James, van der Velden Fabian Johannes Stanislaus, von Both Ulrich, Tsolia Maria N, Zenz Werner, Sagmeister Manfred, Vermont Clementien, de Vries Gabriella, Kolberg Laura, Lim Emma, Pokorn Marko, Zavadska Dace, Martinón-Torres Federico, Rivero-Calle Irene, Hagedoorn Nienke N, Usuf Effua, Schlapbach Luregn, Kuijpers Taco W, Pollard Andrew J, Yeung Shunmay, Fink Colin, Voice Marie, Carrol Enitan, Agyeman Philipp K A, Khanijau Aakash, Paulus Stephane, De Tisham, Herberg Jethro Adam, Levin Michael, van der Flier Michiel, de Groot Ronald, Nijman Ruud, Emonts Marieke, PERFORM consortium
Аннотация
DESIGN: International, multicentre, prospective observational study embedded in PErsonalised Risk assessment in Febrile illness to Optimise Real-life Management across the European Union (PERFORM).
SETTING: Fifteen teaching hospitals in nine European countries.
PARTICIPANTS: Febrile immunocompromised children aged 0-18 years.
METHODS: The Feverkids clinical prediction model predicted the probability of bacterial pneumonia, other SBI or no SBI. Model discrimination, calibration and diagnostic performance at different risk thresholds were assessed. The model was then re-fitted and updated.
RESULTS: Of 558 episodes, 21 had bacterial pneumonia, 104 other SBI and 433 no SBI. Discrimination was 0.83 (95% CI 0.71 to 0.90) for bacterial pneumonia, with moderate calibration and 0.67 (0.61 to 0.72) for other SBIs, with poor calibration. After model re-fitting, discrimination improved to 0.88 (0.79 to 0.96) and 0.71 (0.65 to 0.76) and calibration improved. Predicted risk <1% ruled out bacterial pneumonia with sensitivity 0.95 (0.86 to 1.00) and negative likelihood ratio (LR) 0.09 (0.00 to 0.32). Predicted risk >10% ruled in bacterial pneumonia with specificity 0.91 (0.88 to 0.94) and positive LR 6.51 (3.71 to 10.3). Predicted risk <10% ruled out other SBIs with sensitivity 0.92 (0.87 to 0.97) and negative LR 0.32 (0.13 to 0.57). Predicted risk >30% ruled in other SBIs with specificity 0.89 (0.86 to 0.92) and positive LR 2.86 (1.91 to 4.25).
CONCLUSION: Discrimination and calibration were good for bacterial pneumonia but poorer for other SBIs. The rule-out thresholds have the potential to reduce unnecessary investigations and antibiotics in this high-risk group.