II. Indications
- Evaluation of Febrile Infants Age 1 to 3 months
- Inflammatory markers with greater Positive Predictive Value of serious infection than White Blood Cell Count
III. Labs: C-Reactive Protein (CRP)
- CRP <10 mg/L has a Negative Predictive Value for Sepsis of 99%
- CRP >40 mg/L is more suggestive of serious Bacterial illness (but not sensitive or specific)
- Single CRP is inadequate for reassurance (repeat in 24 hours)
- NSAIDs modify CRP significantly (Ibuprofen increases, Naproxen decreases)
- Bilavsky (2009) Acta Paediatr 98(11): 1776-80 +PMID:19664100 [PubMed]
- McWilliam (2010) Arch Dis Child Educ Pract Ed 95(2): 55-8 +PMID:20351152 [PubMed]
IV. Labs: Procalcitonin (PCT)
- Procalcitonin rapidly increases above normal threshold with fever onset in serious Bacterial Infection
- PCT <0.5 ng/ml has a Negative Predictive Value for serious Bacterial Infection of 90%
- PCT >0.6 (and WBC >19k, blasts >1.8k, Neutrophils >13k) suggests serious Bacterial Infection
- Olaciregui (2009) Arch Dis Child 94(7): 501-5 +PMID:19158133 [PubMed]
- Mahajan (2014) Acad Emerg Med 21(2): 171-9 +PMID:24673673 [PubMed]
V. Labs: Laboratory Score
- Criteria
- Procalcitonin (PCT)
- Score 0: Procalcitonin <0.5 ng/ml
- Score 2: Procalcitonin 0.5 to 1.9 ng/ml
- Score 4: Procalcitonin >= 2.0 ng/ml
- C-Reactive Protein (C-RP)
- Score 0: C-Reactive Protein <40 mg/ml
- Score 2: C-Reactive Protein 40 to 99 mg/ml
- Score 4: C-Reactive Protein >=100 mg/ml
- Urinalysis dipstick
- Score 0: Negative
- Score 1: Urine Dipstick with Leukocyte esterase or nitrite positive
- Procalcitonin (PCT)
- Interpretation
- Score >3 points suggests higher risk for serious Bacterial Infection
- References