You’ve heard of the Philadelphia Criteria. You’ve heard of the Rochester Criteria. But – Step-by-Step?
This is an algorithm developed by European emergency physicians to identify low-risk infants who could be safely managed without lumbar puncture nor empiric antibiotic treatment. After retrospectively validating their algorithm on 1,123 patients, this is their prospective validation in 2,185 – looking for IBI or “Invasive Bacterial Infection” as their primary outcome.
The easiest way to summarize their algorithm and results is by this figure:
Sensitivity and specificity, respectively, were as follows:
- Rochester – 81.6% and 44.5%
- Lab-score – 59.8% and 84.0%
- Step-by-Step – 92.0% and 46.9%
The authors attribute 6 of the 7 missed by Step-by-Step to evaluation early in the disease process – presentation within 2 hours of onset of fever.
Their algorithm is reasonable at face validity, and could be incorporated into a protocol with close follow-up to re-evaluate those early in their disease process. We still have, however, a long way to go regarding specificity.
“Validation of the “Step-by-Step” Approach in the Management of Young Febrile Infants”
http://www.ncbi.nlm.nih.gov/pubmed/27382134