Evidence map›Paper›PMID 37072778›Full record

Trial reportBMC medicine2023

Clinical prediction models for serious infections in children: external validation in ambulatory care.

David A G Bos, Tine De Burghgraeve, An De Sutter, Frank Buntinx, Jan Y Verbakel

Registry-linked trialAbstract readClinical Trial
PubMed Full text at PMC Publisher
In one paragraph

Trial report in BMC medicine, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT02024282 (Validation of a Vital Signs and Symptoms Decision Tree and the Effect of a Point-of- Care CRP Test, Oxygen Saturation, a Brief Intervention and a Parent Leaflet on Diagnosing, Antibiotic Prescribing Rate and Parental Satisfaction in Acutely Ill Children in Primary Care."), which is not on this map. Cited by 3 papers.

0numbers the graph read from it
0cells of the map it votes in
3citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

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.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT02024282 nacompletednot on this map

Validation of a Vital Signs and Symptoms Decision Tree and the Effect of a Point-of- Care CRP Test, Oxygen Saturation, a Brief Intervention and a Parent Leaflet on Diagnosing, Antibiotic Prescribing Rate and Parental Satisfaction in Acutely Ill Children in Primary Care."

TypeinterventionalSponsorKU LeuvenRan2013 to 2014Enrolled8,962ConditionsSepsis, Bacteraemia, Meningitis, AbscessArmsUse of C-reactive protein (CRP) point of care test, Brief intervention and parent leaflet, Finger Pulse Oximeter
3 · Its place in the literature

Who cites it

3 citing papers in PubMed.

  1. Article
  2. Review
  3. Review
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

5 authors.

David A G BosEPI-Centre, Department of Public Health and Primary Care, KU Leuven, 7 Kapucijnenvoer block H - Box 7001, Leuven, 3000, Belgium. david.bos@kuleuven.be.ORCID 0000-0002-1065-0934
Tine De BurghgraeveEPI-Centre, Department of Public Health and Primary Care, KU Leuven, 7 Kapucijnenvoer block H - Box 7001, Leuven, 3000, Belgium.
An De SutterDepartment of Family Practice and Primary Health Care, Ghent University, Ghent, Belgium.
Frank BuntinxDepartment of Public Health and Primary Care, KU Leuven, Leuven, Belgium.
Jan Y VerbakelEPI-Centre, Department of Public Health and Primary Care, KU Leuven, 7 Kapucijnenvoer block H - Box 7001, Leuven, 3000, Belgium.

Funding

Fonds Wetenschappelijk Onderzoek G067509N
6 · The paper itself

Abstract

backgroundEarly distinction between mild and serious infections (SI) is challenging in children in ambulatory care. Clinical prediction models (CPMs), developed to aid physicians in clinical decision-making, require broad external validation before clinical use. We aimed to externally validate four CPMs, developed in emergency departments, in ambulatory care.

methodsWe applied the CPMs in a prospective cohort of acutely ill children presenting to general practices, outpatient paediatric practices or emergency departments in Flanders, Belgium. For two multinomial regression models, Feverkidstool and Craig model, discriminative ability and calibration were assessed, and a model update was performed by re-estimation of coefficients with correction for overfitting. For two risk scores, the SBI score and PAWS, the diagnostic test accuracy was assessed.

resultsA total of 8211 children were included, comprising 498 SI and 276 serious bacterial infections (SBI). Feverkidstool had a C-statistic of 0.80 (95% confidence interval 0.77-0.84) with good calibration for pneumonia and 0.74 (0.70-0.79) with poor calibration for other SBI. The Craig model had a C-statistic of 0.80 (0.77-0.83) for pneumonia, 0.75 (0.70-0.80) for complicated urinary tract infections and 0.63 (0.39-0.88) for bacteraemia, with poor calibration. The model update resulted in improved C-statistics for all outcomes and good overall calibration for Feverkidstool and the Craig model. SBI score and PAWS performed extremely weak with sensitivities of 0.12 (0.09-0.15) and 0.32 (0.28-0.37).

conclusionsFeverkidstool and the Craig model show good discriminative ability for predicting SBI and a potential for early recognition of SBI, confirming good external validity in a low prevalence setting of SBI. The SBI score and PAWS showed poor diagnostic performance.

trial registrationClinicalTrials.gov, NCT02024282. Registered on 31 December 2013.

Indexed as

Bacterial InfectionsModels, StatisticalAmbulatory CareChildChlorobenzenesHumansPrognosisProspective StudiesSulfides4-chlorophenyl methyl sulfideChlorobenzenesSulfidesChildrenClinical prediction modelsDiagnostic accuracyEmergency medicineExternal validationGeneral practiceModel updatingPaediatricsSerious infections

Identifiers

PMID37072778
PMCPMC10114467

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Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.