Abstract
(1) Background: Young infants have a high risk of serious infection. The Systematic Inflammatory Response Syndrome (SIRS) criteria can be useful to identify both serious bacterial and viral infections. The aims of this study were to evaluate the diagnostic performance of the SIRS criteria for identifying serious infections in febrile young infants and to identify potential clinical predictors of such infections. (2) Methods: We conducted this prospective cohort study including febrile young infants (aged < 90 days) seen at the emergency department with a body temperature of 38.0 °C or higher. We calculated the diagnostic performance parameters and conducted the logistic regression analysis to identify the predictors of serious infection. (3) Results: Of 311 enrolled patients, 36.7% (n = 114) met the SIRS criteria and 28.6% (n = 89) had a serious infection. The sensitivity, specificity, positive predictive value, and positive likelihood ratio of the SIRS criteria for serious infection was 45.9%, 69.4%, 43.5%, 71.4%, 1.5, and 0.8, respectively. Logistic regression showed that male gender, body temperature ≥ 38.5 °C, heart rate ≥ 178 bpm, and age ≤ 50 days were significant predictors. (4) Conclusions: The performance of the SIRS criteria for predicting serious infections among febrile young infants was poor.
Highlights
Young infants have a high risk of developing serious infections (SIs) due to their greater susceptibility to pathogens and problems with clinical examination that may cause potential infections to be overlooked [1,2]
The clinical care of febrile young infants has focused on identifying serious bacterial infections requiring early intervention with antibiotics
A study of adult sepsis showed that diagnostic performance measures such as sensitivity and specificity of the Systematic Inflammatory Response Syndrome (SIRS) criteria were inferior to those of Sequential Organ Failure Assessment (SOFA) [25]
Summary
Young infants (aged < 90 days) have a high risk of developing serious infections (SIs) due to their greater susceptibility to pathogens and problems with clinical examination that may cause potential infections to be overlooked [1,2]. Traditionally, the clinical care of febrile young infants has focused on identifying serious bacterial infections requiring early intervention with antibiotics. Recent studies have shown the importance of diagnosing viral infections in the emergency department (ED) due to the fact that several types of viral infection can cause respiratory failure, septic shock, or central nervous system dysfunction requiring intensive care, possibly resulting in unfavorable outcomes in young infants [3,4,5,6]. This has led some researchers to argue for the need to diagnose viral infections in infants [7,8,9]. These diagnostic tools have expedited clinicians’ decision making and helped to improve the use of resources in pediatric acute care [12,13], clinicians may still misdiagnose serious viral infections if they rely only on methods used to diagnose bacterial infections [14,15]
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