EFFICACY OF AN OBSERVATION SCALE IN DETECTING BACTEREMIA IN FEBRILE CHILDREN 3 TO 36 MONTHS OF AGE, TREATED AS OUTPATIENTS

Objective: To assess the efficacy of the Yale Observation Scale (YOS) in detecting occult bacteremia in febrile, ambulatory pediatric patien ts with no apparent signs or symptoms of severe infection and with no focal infection. Design: YOS scores were assigned as part of a prospec tive, multicenter, randomized, interventional trial of oral and intram uscular antibiotics in preventing the complications of occult bacterem ia in febrile children. Setting: Pediatric emergency departments at ei ght urban medical centers. Participants: Children, 3 to 36 months of a ge with a temperature at least 39.0 degrees C, a nonfocal, non-toxic-a ppearing illness (or uncomplicated otitis media), treated as outpatien ts. Interventions: None. Results: There were 6611 assessable patients, who had both a blood culture result and a YOS score assigned. The med ian YOS score for both patients with bacteremia (n = 192) and patients without bacteremia (n = 6419) was 6, but the mean rank among patients with bacteremia was significantly higher (p <0.0001). The sensitivity , specificity, and positive and negative predictive values for a YOS s core greater than 10 were 5.2%, 96.7%, 4.5%, and 97.1%, respectively. Conclusions: The YOS scores are higher among patients with bacteremia than among patients without bacteremia, but the difference is not clin ically useful in defecting occult bacteremia in febrile children, with nonfocal, apparently nontoxic infection, treated as outpatients in th is age group.