ArticleHospital pediatrics2023
Performance of AAP Clinical Practice Guideline for Febrile Infants at One Pediatric Hospital.
Article in Hospital pediatrics, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 4 papers.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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Who cites it
4 citing papers in PubMed.
- Development of a machine learning-based prediction model for serious bacterial infections in febrile young infants.BMJ paediatrics open · 2025Article
- Scoping review of clinical decision aids in the assessment and management of febrile infants under 90 days of age.BMC pediatrics · 2025Article
- External Validation of Brief Resolved Unexplained Events Prediction Rules for Serious Underlying Diagnosis.JAMA pediatrics · 2025Article
- Performance of AAP CPG for Ineligible Well-Appearing Febrile Infants Aged 8-60 Days.Hospital pediatrics · 2024Article
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Authors and funding
7 authors.
Funding
Abstract
backgroundIn the absence of procalcitonin, the American Academy of Pediatrics' clinical practice guideline (CPG) for evaluating and managing febrile infants recommends using previously untested combinations of inflammatory marker thresholds. Thus, CPG performance in detecting invasive bacterial infections (IBIs; bacteremia, bacterial meningitis) is poorly understood.
objectiveTo evaluate CPG performance without procalcitonin in detecting IBIs in well-appearing febrile infants 8 to 60 days old.
methodsFor this cross-sectional, single-site study, we manually abstracted data for febrile infants using electronic health records from 2011 to 2018. We used CPG inclusion/exclusion criteria to identify eligible infants and stratified IBI risk with CPG inflammatory marker thresholds for temperature, absolute neutrophil count, and C-reactive protein. Because the CPG permits a wide array of interpretations, we performed 3 sensitivity analyses, modifying age and inflammatory marker thresholds. For each approach, we calculated area-under-the-receiver operating characteristic curve, sensitivity, and specificity in detecting IBIs.
resultsFor this study, 507 infants met the inclusion criteria. For the main analysis, we observed an area-under-the-receiver operating characteristic curve of 0.673 (95% confidence interval 0.652-0.694), sensitivity of 100% (66.4%-100%), and specificity of 34.5% (30.4%-38.9%). For the sensitivity analyses, sensitivities were all 100% and specificities ranged from 9% to 38%.
conclusionFindings suggest that the CPG is highly sensitive, minimizing missed IBIs, but specificity may be lower than previously reported. Future studies should prospectively investigate CPG performance in larger, multisite samples.
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