Procalcitonin, can it help screen and identify febrile infants/kids with serious bacterial infection
The Article: Procalcitonin as a marker of serious bacterial infections in febrile children younger than 3 years old. ACADEMIC EMERGENCY MEDICINE. Feb 2014, Vol 21, No 2
The Idea: Whether using serum procalcitonin, in comparison to other traditional screening tests, would be more beneficial in detecting serious bacterial infections in your febrile infants/children.
The Study: 226 well appearing febrile children (rectal temp of >38C in ages <3mo or rectal temp >39C if >3mo) with no other apparent sources of infection (no hx of anti-biotics use, could not be premature or have known immunologic/systemic disease, no immunizations in past 2 days). ED doctor had discretion of ordering labs (blood cultures, urine cultures, LP etc) when blood was obtained, an extra 1mL was collected for the purpose of this study.
The Findings: Procalcitonin was indeed a more accurate biomarker in identifying young febrile infants/children with serious bacterial infections, area under the ROC was better than any other markers. Of note, procalcitonin had a sensitivity of 51-53% with a specificity of 90-92%.
The takeaway: Procalcitonin is highly specific which is not going to help the fellow ED physician screen febrile young infants/children. More research needs to be done before trying to use procalcitonin as the only value to help determine care/investigation of febrile children.