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External validation of a multivariable prediction model for identification of pneumonia and other serious bacterial infections in febrile immunocompromised children

Lookup NU author(s): Dr Alexander Martin, Fabian Van Der Velden, Dr Emma Lim, Professor Marieke Emonts-le ClercqORCiD



This work is licensed under a Creative Commons Attribution 4.0 International License (CC BY 4.0).


© 2023 Author(s). Published by BMJ.Objective: To externally validate and update the Feverkids tool clinical prediction model for differentiating bacterial pneumonia and other serious bacterial infections (SBIs) from non-SBI causes of fever in immunocompromised children. Design: International, multicentre, prospective observational study embedded in PErsonalised Risk assessment in Febrile illness to Optimise Real-life Management across the European Union (PERFORM). Setting: Fifteen teaching hospitals in nine European countries. Participants: Febrile immunocompromised children aged 0-18 years. Methods: The Feverkids clinical prediction model predicted the probability of bacterial pneumonia, other SBI or no SBI. Model discrimination, calibration and diagnostic performance at different risk thresholds were assessed. The model was then re-fitted and updated. Results: Of 558 episodes, 21 had bacterial pneumonia, 104 other SBI and 433 no SBI. Discrimination was 0.83 (95% CI 0.71 to 0.90) for bacterial pneumonia, with moderate calibration and 0.67 (0.61 to 0.72) for other SBIs, with poor calibration. After model re-fitting, discrimination improved to 0.88 (0.79 to 0.96) and 0.71 (0.65 to 0.76) and calibration improved. Predicted risk <1% ruled out bacterial pneumonia with sensitivity 0.95 (0.86 to 1.00) and negative likelihood ratio (LR) 0.09 (0.00 to 0.32). Predicted risk >10% ruled in bacterial pneumonia with specificity 0.91 (0.88 to 0.94) and positive LR 6.51 (3.71 to 10.3). Predicted risk <10% ruled out other SBIs with sensitivity 0.92 (0.87 to 0.97) and negative LR 0.32 (0.13 to 0.57). Predicted risk >30% ruled in other SBIs with specificity 0.89 (0.86 to 0.92) and positive LR 2.86 (1.91 to 4.25). Conclusion: Discrimination and calibration were good for bacterial pneumonia but poorer for other SBIs. The rule-out thresholds have the potential to reduce unnecessary investigations and antibiotics in this high-risk group.

Publication metadata

Author(s): Martin AJ, Van Der Velden FJS, Von Both U, Tsolia MN, Zenz W, Sagmeister M, Vermont C, De Vries G, Kolberg L, Lim E, Pokorn M, Zavadska D, Martinon-Torres F, Rivero-Calle I, Hagedoorn NN, Usuf E, Schlapbach L, Kuijpers TW, Pollard AJ, Yeung S, Fink C, Voice M, Carrol E, Agyeman PKA, Khanijau A, Paulus S, De T, Herberg JA, Levin M, Van Der Flier M, De Groot R, Nijman R, Emonts M

Publication type: Article

Publication status: Published

Journal: Archives of Disease in Childhood

Year: 2024

Volume: 109

Issue: 1

Pages: 58-66

Print publication date: 01/01/2024

Online publication date: 27/08/2023

Acceptance date: 14/08/2023

Date deposited: 09/09/2023

ISSN (print): 0003-9888

ISSN (electronic): 1468-2044

Publisher: BMJ Publishing Group


DOI: 10.1136/archdischild-2023-325869

ePrints DOI: 10.57711/ha9k-ev77

PubMed id: 37640431


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Funder referenceFunder name
European Union’s Horizon 2020
NIHR Biomedical Research Centres