Abstract

Blood culture is frequently used to detect bacteremia in febrile children. However, a high rate of negative or false-positive blood culture results is common at the pediatric emergency department (PED). The aim of this study was to use machine learning to build a model that could predict bacteremia in febrile children. We conducted a retrospective case-control study of febrile children who presented to the PED from 2008 to 2015. We adopted machine learning methods and cost-sensitive learning to establish a predictive model of bacteremia. We enrolled 16,967 febrile children with blood culture tests during the eight-year study period. Only 146 febrile children had true bacteremia, and more than 99% of febrile children had a contaminant or negative blood culture result. The maximum area under the curve of logistic regression and support vector machines to predict bacteremia were 0.768 and 0.832, respectively. Using the predictive model, we can categorize febrile children by risk value into five classes. Class 5 had the highest probability of having bacteremia, while class 1 had no risk. Obtaining blood cultures in febrile children at the PED rarely identifies a causative pathogen. Prediction models can help physicians determine whether patients have bacteremia and may reduce unnecessary expenses.

Highlights

  • Fever is one of the most frequent reasons for visits to the Pediatric Emergency Department (PED) [1,2], and estimates say that up to 10% to 25% of cases with febrile illness had bacterial infection [3,4]

  • Among a total of 266,679 children that visited the pediatric emergency department (PED) during the 8-year period, 16,967 febrile children with blood culture tests were enrolled for further analysis

  • Percentage of neutrophil and band, absolute neutrophil count (ANC), Hb, platelet, and C-reactive protein (CRP) were statistically different between bacteremia and non-bacteremia encounters

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Summary

Introduction

Fever is one of the most frequent reasons for visits to the Pediatric Emergency Department (PED) [1,2], and estimates say that up to 10% to 25% of cases with febrile illness had bacterial infection [3,4]. Bacteremia is a severe bacterial infection that can be detected by a blood culture, one of the most frequently ordered microbiological tests in the PED [6]. Blood cultures remain the gold standard test for detecting patients with bacteremia. Isolating the organism from the blood can confirm a diagnosis, which helps physicians identify the cause of the infection and administer the appropriate antimicrobial agents. Upon receiving a blood culture result, physicians must decide whether the organism represents a clinically significant infection [6,7,8].

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