{
  "abstract": "Objective To externally validate the Paediatric Emergency Care Applied Research Network (PECARN) rule for identifying febrile infants aged <60 days at low risk of serious bacterial infections (SBIs) and assess the utility of the rule with C reactive protein (CRP) instead of procalcitonin (PCT).Methods Secondary analysis of data from the Management and Outcomes of Fever in Children in Europe (MOFICHE) study (12 paediatric emergency departments in eight European countries, January 2017 to April 2018) and a Swedish study (four paediatric emergency departments, January 2014 to December 2020). Previously healthy febrile infants aged ≤60 days were included. We validated the original PECARN rule in a Swedish subcohort (2018–2020) and explored an adapted version using CRP in the full Swedish and MOFICHE cohorts.Results The Swedish subcohort (2018–2020) included 536 febrile infants with an SBI prevalence of 11%. The original PECARN rule showed a sensitivity of 96.6% (95% CI 88.1 to 99.6), specificity of 61.9% (95% CI 57.4 to 66.3), negative predictive value (NPV) of 99.3% (95% CI 97.4 to 99.8) and positive predictive value (PPV) of 23.5% (95% CI 21.4 to 25.8). The full Swedish cohort (2014–2020) included 2237 infants and the MOFICHE cohort of 512 infants with 12% and 10% SBI prevalence, respectively. Using CRP <20 mg/L instead of PCT, the adapted PECARN rule showed a sensitivity of 97.8% and NPV of 99.4% in the Swedish cohort, and sensitivity of 92.2% with an NPV of 98.3% in the MOFICHE cohort.Conclusions The PECARN rule demonstrated high NPV (similar to the derivation cohort) and high potential in ruling out SBIs in two new European cohorts. The rule maintained good performance with CRP instead of PCT, supporting the potential use of CRP in settings where PCT is unavailable.",
  "authors": [
    {
      "affiliations": [
        "Department of Clinical Sciences, Lund University Faculty of Medicine, Lund, Sweden",
        "Department of Pediatrics, Skåne University Hospital, Malmo, Sweden"
      ],
      "name": "Ioannis Orfanos"
    },
    {
      "affiliations": [
        "Department of General Pediatrics, Erasmus MC Sophia, Rotterdam, The Netherlands"
      ],
      "name": "Sanne Vrijlandt"
    },
    {
      "affiliations": [
        "Department of General Pediatrics, Erasmus MC Sophia, Rotterdam, The Netherlands"
      ],
      "name": "Eline van der Walle"
    },
    {
      "affiliations": [
        "Erasmus Medical Centre Department of General Pediatrics, Rotterdam, The Netherlands"
      ],
      "name": "Chantal D Tan"
    },
    {
      "affiliations": [
        "Public Health, Erasmus MC, Rotterdam, The Netherlands"
      ],
      "name": "Daan Nieboer"
    },
    {
      "affiliations": [
        "Department of Global Public Health, Karolinska Institute, Stockholm, Sweden",
        "Sach’s Children and Youth Hospital, Stockholm, Sweden"
      ],
      "name": "Tobias Alfvén"
    },
    {
      "affiliations": [
        "Department of Pediatrics, Skåne University Hospital, Malmo, Sweden"
      ],
      "name": "Jorge Sotoca Fernandez"
    },
    {
      "affiliations": [
        "Department of Clinical Sciences, Lund University, Lund, Sweden"
      ],
      "name": "Matilda Elliver"
    },
    {
      "affiliations": [
        "Department of Pediatrics, Institution for Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Goteborg, Sweden",
        "School of Public Health and Community Medicine, Institution for Medicine, Sahlgrenska Academy, University of Gothenburg, Goteborg, Sweden"
      ],
      "name": "Kristina Elfving"
    },
    {
      "affiliations": [
        "Vaccines, Infections and Paediatrics Research Group (GENVIP), Hospital Clinico Universitario de Santiago, Santiago de Compostela, Spain"
      ],
      "name": "Federico Martinón-Torres"
    },
    {
      "affiliations": [
        "Department of General Paediatrics, Medical University of Graz, Graz, Austria"
      ],
      "name": "Benno Kohlmaier"
    },
    {
      "affiliations": [
        "Department of General Paediatrics, Medical University of Graz, Graz, Austria"
      ],
      "name": "Werner Zenz"
    },
    {
      "affiliations": [
        "Paediatric Immunology, Infectious Diseases & Allergy, Newcastle upon Tyne Hospitals NHS Foundation Trust, Great North Children’s Hospital, Newcastle upon Tyne, UK",
        "Newcastle University Translational and Clinical Research Institute, Newcastle upon Tyne, UK"
      ],
      "name": "Marieke Emonts"
    },
    {
      "affiliations": [
        "Faculty of Medicine, Department of Infectious Diseases, Section of Paediatric Infectious Diseases, Imperial College London, London, UK",
        "Department of Paediatric Emergency Medicine, Imperial College Healthcare NHS Trust, London, UK"
      ],
      "name": "Ruud Gerard Nijman"
    },
    {
      "affiliations": [
        "Department of Clinical Infection, Microbiology and Immunology, University of Liverpool Institute of Infection Veterinary and Ecological Sciences, Liverpool, UK",
        "Department of Infectious Diseases, Alder Hey Children’s Alder Hey Children’s NHS Foundation Trust, Liverpool, UK"
      ],
      "name": "Enitan Carrol"
    },
    {
      "affiliations": [
        "Department of Pediatrics, Skåne University Hospital, Malmo, Sweden",
        "Department of Clinical Sciences, Lund University, Lund, Sweden"
      ],
      "name": "Erik Eklund"
    },
    {
      "affiliations": [
        "Erasmus MC-Sophia Childrens Hospital, Rotterdam, The Netherlands"
      ],
      "name": "Henriette A Moll"
    },
    {
      "affiliations": [
        "Department of General Pediatrics, Erasmus MC Sophia, Rotterdam, The Netherlands"
      ],
      "name": "Rianne Oostenbrink"
    }
  ],
  "title": "Validating the PECARN rule to identify febrile infants at low risk of serious bacterial infections: an international validation study",
  "uid": "2439f348-6835-5687-92c2-1fc42b973407"
}