Impact of the lab-score on antibiotic prescription rate in children with fever without source: a randomized controlled trial
The Lab-score, based on the combined determination of procalcitonin, C-reactive protein and urinary dipstick results, has been shown accurate in detecting serious bacterial infections (SBI) in children with fever without source (FWS) on retrospective cohorts. We aimed to prospectively assess the uti...
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| description | The Lab-score, based on the combined determination of procalcitonin, C-reactive protein and urinary dipstick results, has been shown accurate in detecting serious bacterial infections (SBI) in children with fever without source (FWS) on retrospective cohorts. We aimed to prospectively assess the utility of the Lab-score in safely decreasing antibiotic prescriptions in children with FWS and to determine its diagnostic characteristics compared to common SBI biomarkers.
Randomized controlled trial in children 7 days to 36 months old with FWS, allocated either to the Lab-score group (Lab-score reported, blinded WBC count) or to the control group (WBC, bands and C-reactive protein determined, blinded procalcitonin and Lab-score), followed up until recovery. Demographic data, antibiotic prescription rate, admission rate and diagnostic properties of the Lab-score were analyzed.
271 children were analyzed. No statistically significant difference concerning antibiotic prescription rate was observed: 41.2% (54 of 131) in the Lab-score group and 42.1% (59 of 140) in the control group (p = 1.000). If recommendations based on the Lab-score had been strictly applied, a hypothetical 30.6% treatment rate would have been encountered, compared to the overall 41.7% observed rate (p = 0.0095). A Lab-score ≥3 showed the following characteristics: sensitivity 85.1% (95% CI: 76.5-93.6%), specificity 87.3% (95% CI: 82.7-91.8%), positive predictive value 68.7% (95% CI: 58.7-78.7%), negative predictive value 94.1% (95% CI: 91.5-97.9%), positive and negative likelihood ratios: 6.68 and 0.17 respectively. Area under the receiver operating characteristic curve was best for the Lab-score (0.911, 95% CI: 0.871-0.950).
No difference regarding antibiotic treatment rate was observed when using the Lab-score, due to lack of adherence to the related recommendations. However, if strictly followed, a significant 26.5% reduction of antibiotic prescriptions would have been encountered. Medical education needs to be reinforced in order to observe rather than treat low-risk well-appearing children with FWS.
ClinicalTrials.gov NCT02179398. |
| doi_str_mv | 10.1371/journal.pone.0115061 |
| format | Article |
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Randomized controlled trial in children 7 days to 36 months old with FWS, allocated either to the Lab-score group (Lab-score reported, blinded WBC count) or to the control group (WBC, bands and C-reactive protein determined, blinded procalcitonin and Lab-score), followed up until recovery. Demographic data, antibiotic prescription rate, admission rate and diagnostic properties of the Lab-score were analyzed.
271 children were analyzed. No statistically significant difference concerning antibiotic prescription rate was observed: 41.2% (54 of 131) in the Lab-score group and 42.1% (59 of 140) in the control group (p = 1.000). If recommendations based on the Lab-score had been strictly applied, a hypothetical 30.6% treatment rate would have been encountered, compared to the overall 41.7% observed rate (p = 0.0095). A Lab-score ≥3 showed the following characteristics: sensitivity 85.1% (95% CI: 76.5-93.6%), specificity 87.3% (95% CI: 82.7-91.8%), positive predictive value 68.7% (95% CI: 58.7-78.7%), negative predictive value 94.1% (95% CI: 91.5-97.9%), positive and negative likelihood ratios: 6.68 and 0.17 respectively. Area under the receiver operating characteristic curve was best for the Lab-score (0.911, 95% CI: 0.871-0.950).
No difference regarding antibiotic treatment rate was observed when using the Lab-score, due to lack of adherence to the related recommendations. However, if strictly followed, a significant 26.5% reduction of antibiotic prescriptions would have been encountered. Medical education needs to be reinforced in order to observe rather than treat low-risk well-appearing children with FWS.
ClinicalTrials.gov NCT02179398.</description><identifier>ISSN: 1932-6203</identifier><identifier>EISSN: 1932-6203</identifier><identifier>DOI: 10.1371/journal.pone.0115061</identifier><identifier>PMID: 25503770</identifier><language>eng</language><publisher>United States: Public Library of Science</publisher><subject>Anti-Bacterial Agents - administration & dosage ; Antibiotics ; Bacterial infections ; Bacterial Infections - drug therapy ; Bacterial Infections - pathology ; Biomarkers ; Biomarkers - metabolism ; C-reactive protein ; C-Reactive Protein - metabolism ; Calcitonin - blood ; Calcitonin Gene-Related Peptide ; Children ; Comparative analysis ; Control methods ; Data recovery ; Demographics ; Diagnostic systems ; Female ; Fever ; Fever - blood ; Fever - drug therapy ; Fever - pathology ; Humans ; Infant ; Infant, Newborn ; Infection ; Leukocyte Count ; Male ; Medical diagnosis ; Medicine and Health Sciences ; Pediatric pharmacology ; Procalcitonin ; Protein Precursors - blood ; Randomization ; Statistical analysis ; Urinary tract infections</subject><ispartof>PloS one, 2014-12, Vol.9 (12), p.e115061-e115061</ispartof><rights>COPYRIGHT 2014 Public Library of Science</rights><rights>2014 Lacroix et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License: http://creativecommons.org/licenses/by/4.0/ (the “License”), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><rights>2014 Lacroix et al 2014 Lacroix et al</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c692t-896a23fe3c4f21e18531adc169e97cc39ac0def2fce429a16aec1ee9fd4ed2213</citedby><cites>FETCH-LOGICAL-c692t-896a23fe3c4f21e18531adc169e97cc39ac0def2fce429a16aec1ee9fd4ed2213</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC4263728/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC4263728/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,314,723,776,780,860,881,2096,2915,23845,27901,27902,53766,53768,79569,79570</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/25503770$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Lacroix, Laurence</creatorcontrib><creatorcontrib>Manzano, Sergio</creatorcontrib><creatorcontrib>Vandertuin, Lynda</creatorcontrib><creatorcontrib>Hugon, Florence</creatorcontrib><creatorcontrib>Galetto-Lacour, Annick</creatorcontrib><creatorcontrib>Gervaix, Alain</creatorcontrib><title>Impact of the lab-score on antibiotic prescription rate in children with fever without source: a randomized controlled trial</title><title>PloS one</title><addtitle>PLoS One</addtitle><description>The Lab-score, based on the combined determination of procalcitonin, C-reactive protein and urinary dipstick results, has been shown accurate in detecting serious bacterial infections (SBI) in children with fever without source (FWS) on retrospective cohorts. We aimed to prospectively assess the utility of the Lab-score in safely decreasing antibiotic prescriptions in children with FWS and to determine its diagnostic characteristics compared to common SBI biomarkers.
Randomized controlled trial in children 7 days to 36 months old with FWS, allocated either to the Lab-score group (Lab-score reported, blinded WBC count) or to the control group (WBC, bands and C-reactive protein determined, blinded procalcitonin and Lab-score), followed up until recovery. Demographic data, antibiotic prescription rate, admission rate and diagnostic properties of the Lab-score were analyzed.
271 children were analyzed. No statistically significant difference concerning antibiotic prescription rate was observed: 41.2% (54 of 131) in the Lab-score group and 42.1% (59 of 140) in the control group (p = 1.000). If recommendations based on the Lab-score had been strictly applied, a hypothetical 30.6% treatment rate would have been encountered, compared to the overall 41.7% observed rate (p = 0.0095). A Lab-score ≥3 showed the following characteristics: sensitivity 85.1% (95% CI: 76.5-93.6%), specificity 87.3% (95% CI: 82.7-91.8%), positive predictive value 68.7% (95% CI: 58.7-78.7%), negative predictive value 94.1% (95% CI: 91.5-97.9%), positive and negative likelihood ratios: 6.68 and 0.17 respectively. Area under the receiver operating characteristic curve was best for the Lab-score (0.911, 95% CI: 0.871-0.950).
No difference regarding antibiotic treatment rate was observed when using the Lab-score, due to lack of adherence to the related recommendations. However, if strictly followed, a significant 26.5% reduction of antibiotic prescriptions would have been encountered. Medical education needs to be reinforced in order to observe rather than treat low-risk well-appearing children with FWS.
ClinicalTrials.gov NCT02179398.</description><subject>Anti-Bacterial Agents - administration & dosage</subject><subject>Antibiotics</subject><subject>Bacterial infections</subject><subject>Bacterial Infections - drug therapy</subject><subject>Bacterial Infections - pathology</subject><subject>Biomarkers</subject><subject>Biomarkers - metabolism</subject><subject>C-reactive protein</subject><subject>C-Reactive Protein - metabolism</subject><subject>Calcitonin - blood</subject><subject>Calcitonin Gene-Related Peptide</subject><subject>Children</subject><subject>Comparative analysis</subject><subject>Control methods</subject><subject>Data recovery</subject><subject>Demographics</subject><subject>Diagnostic systems</subject><subject>Female</subject><subject>Fever</subject><subject>Fever - blood</subject><subject>Fever - drug therapy</subject><subject>Fever - pathology</subject><subject>Humans</subject><subject>Infant</subject><subject>Infant, Newborn</subject><subject>Infection</subject><subject>Leukocyte Count</subject><subject>Male</subject><subject>Medical diagnosis</subject><subject>Medicine and Health Sciences</subject><subject>Pediatric pharmacology</subject><subject>Procalcitonin</subject><subject>Protein Precursors - 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Academic</collection><collection>PubMed Central (Full Participant titles)</collection><collection>DOAJ Directory of Open Access Journals</collection><jtitle>PloS one</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Lacroix, Laurence</au><au>Manzano, Sergio</au><au>Vandertuin, Lynda</au><au>Hugon, Florence</au><au>Galetto-Lacour, Annick</au><au>Gervaix, Alain</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Impact of the lab-score on antibiotic prescription rate in children with fever without source: a randomized controlled trial</atitle><jtitle>PloS one</jtitle><addtitle>PLoS One</addtitle><date>2014-12-11</date><risdate>2014</risdate><volume>9</volume><issue>12</issue><spage>e115061</spage><epage>e115061</epage><pages>e115061-e115061</pages><issn>1932-6203</issn><eissn>1932-6203</eissn><abstract>The Lab-score, based on the combined determination of procalcitonin, C-reactive protein and urinary dipstick results, has been shown accurate in detecting serious bacterial infections (SBI) in children with fever without source (FWS) on retrospective cohorts. We aimed to prospectively assess the utility of the Lab-score in safely decreasing antibiotic prescriptions in children with FWS and to determine its diagnostic characteristics compared to common SBI biomarkers.
Randomized controlled trial in children 7 days to 36 months old with FWS, allocated either to the Lab-score group (Lab-score reported, blinded WBC count) or to the control group (WBC, bands and C-reactive protein determined, blinded procalcitonin and Lab-score), followed up until recovery. Demographic data, antibiotic prescription rate, admission rate and diagnostic properties of the Lab-score were analyzed.
271 children were analyzed. No statistically significant difference concerning antibiotic prescription rate was observed: 41.2% (54 of 131) in the Lab-score group and 42.1% (59 of 140) in the control group (p = 1.000). If recommendations based on the Lab-score had been strictly applied, a hypothetical 30.6% treatment rate would have been encountered, compared to the overall 41.7% observed rate (p = 0.0095). A Lab-score ≥3 showed the following characteristics: sensitivity 85.1% (95% CI: 76.5-93.6%), specificity 87.3% (95% CI: 82.7-91.8%), positive predictive value 68.7% (95% CI: 58.7-78.7%), negative predictive value 94.1% (95% CI: 91.5-97.9%), positive and negative likelihood ratios: 6.68 and 0.17 respectively. Area under the receiver operating characteristic curve was best for the Lab-score (0.911, 95% CI: 0.871-0.950).
No difference regarding antibiotic treatment rate was observed when using the Lab-score, due to lack of adherence to the related recommendations. However, if strictly followed, a significant 26.5% reduction of antibiotic prescriptions would have been encountered. Medical education needs to be reinforced in order to observe rather than treat low-risk well-appearing children with FWS.
ClinicalTrials.gov NCT02179398.</abstract><cop>United States</cop><pub>Public Library of Science</pub><pmid>25503770</pmid><doi>10.1371/journal.pone.0115061</doi><oa>free_for_read</oa></addata></record> |
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| recordid | cdi_plos_journals_1635249464 |
| source | Public Library of Science (PLoS) Journals Open Access; MEDLINE; DOAJ Directory of Open Access Journals; Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals; PubMed Central; Free Full-Text Journals in Chemistry |
| subjects | Anti-Bacterial Agents - administration & dosage Antibiotics Bacterial infections Bacterial Infections - drug therapy Bacterial Infections - pathology Biomarkers Biomarkers - metabolism C-reactive protein C-Reactive Protein - metabolism Calcitonin - blood Calcitonin Gene-Related Peptide Children Comparative analysis Control methods Data recovery Demographics Diagnostic systems Female Fever Fever - blood Fever - drug therapy Fever - pathology Humans Infant Infant, Newborn Infection Leukocyte Count Male Medical diagnosis Medicine and Health Sciences Pediatric pharmacology Procalcitonin Protein Precursors - blood Randomization Statistical analysis Urinary tract infections |
| title | Impact of the lab-score on antibiotic prescription rate in children with fever without source: a randomized controlled trial |
| url | https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2025-02-21T19%3A49%3A10IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-gale_plos_&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Impact%20of%20the%20lab-score%20on%20antibiotic%20prescription%20rate%20in%20children%20with%20fever%20without%20source:%20a%20randomized%20controlled%20trial&rft.jtitle=PloS%20one&rft.au=Lacroix,%20Laurence&rft.date=2014-12-11&rft.volume=9&rft.issue=12&rft.spage=e115061&rft.epage=e115061&rft.pages=e115061-e115061&rft.issn=1932-6203&rft.eissn=1932-6203&rft_id=info:doi/10.1371/journal.pone.0115061&rft_dat=%3Cgale_plos_%3EA418635441%3C/gale_plos_%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_pqid=1635249464&rft_id=info:pmid/25503770&rft_galeid=A418635441&rft_doaj_id=oai_doaj_org_article_7ea032f2094d4c60aa9b76a8174bf176&rfr_iscdi=true |