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Aim: To compare diagnostic accuracy of procalcitonin for early diagnosis of s erious bacterial infection (SBI) in children presenting with fever and no focus of infection. Methods: Prospective, observational study involving 72 children (1 - 36 mo) presenting to the paediatric units of two university hospitals. All ch ildren had blood cultures, urine cultures, white blood cell counts (WBC), chest X- ray, C- reactive protein (CRP)- and procalcitonin (PCT) done at presentati on. Results: Eight (11.1% ) children had SBI (1 pneumonia, 2 meningitis, 4 sept icaemia/ occult bacteraemia, 2 pyelonephritis), 19 (26.4% ) had possible bacter ial infection (received antibiotic treatment, but no organism grown) and 45 (62. 5% ) had viral or possible viral infection (virus isolated and/or uneventful re covery without antibiotics). PCT (> 2 ng/l), CRP(>50 mg/l) and McCarthy’s scor e ( < 9) had sensitivities and specificities of 50% /85.9% , 75% /68.7% and 87.5% /67.2% , respectively. Negative and positive likelihood ratios for CRP ( > 5 0 mg/l), PCT ( > 2 ng/l), white blood cells ( > 15 × 109/l) and McCarthy’s score ( < 9)were 0.36/2.4, 0.58/ 3.5, 0.94/1.1 and 0.19/2.7, respectively. A com bination of PCT, CRP and WBC generated a positive likelihood ratio of 10.6, chan ging the post- test probability to 54% . Conclusion: For early diagnosis of SB I in children presenting with fever and no focus of infection, the diagnostic ut ility of procalcitonin is similar to the traditional markers infection and clini cal scoring. While a low procalcitonin level cannot be used to exclude SBI in th is population, a combination of PCT, CRP and WBC may be more useful in predictin g SBI.
Methods: Prospective, observational study involving 72 children (1-36 mo) presenting to the pediatric unit (SBI) in children with fever and no focus of infection. Aim: To compare diagnostic accuracy of procalcitonin for early diagnosis of s erious bacterial infection of two university hospitals. All children had blood cultures, urine cultures, white blood cell counts (WBC), chest X- ray, C-reactive protein 11.1%) had had bacter ial infection (received antibiotic treatment, but no organism grown) and 45 (62.5%) had had SBI (1 pneumonia, 2 meningitis, 4 septicaemia / occult bacteraemia, 2 pyelonephritis) (> 2 ng / l), CRP (> 50 mg / l) and McCarthy’s scor e (<9) had sensitivities and specificities of 50% /85.9%, 75% /68.7% and 87.5% /67.2%, respectively. Negative and posit Iverability ratios for CRP (> 50 mg / l), PCT (> 2 ng / l), white blood cells (> 15 × 109 / l) and McCarthy’s score (<9) were 0.36 / 2.4 and 0.58 / 0.94 / 1.1 and 0.19 / 2.7, respectively. A com bination of PCT, CRP and WBC generated a positive likelihood ratio of 10.6, chan ging the post-test probability to 54%. Conclusion: For early diagnosis of SB I in children presenting with fever and no focus of infection, the diagnostic ut ility of procalcitonin is similar to the traditional markers infection and clini cal scoring. While a low procalcitonin level can not be used to exclude SBI in th is population, a combination of PCT, CRP and WBC may be more useful in predictin g SBI.