A5V4d

Management by the paediatric specialist
retrospective (Olaciregui et al., 2009; Gomez et al., 2010). All the studies investigated populations
with suspected bacterial illness.
Six studies (Guen et al., 2007; Olaciregui et al., 2009; Isaacman et al, 2002; Pratt et al, 2007; Pulliam
et al, 2001; Gomez et al, 2010) investigated the same infection (bacteremia); the rest assessed a
range of infections. Five studies carried out subgroup analyses. Andreola (2007) performed a
subgroup analysis by duration of evolution of fever. Lacour (2001) split the results by age (younger
than12 months and 12 months or older). Manzano (2011) reported separate results for children who
had normal urine analysis. Pratt (2007) examined differences between children who presented less
than 12 hours after becoming febrile and those who presented more than 12 hours after becoming
febrile. Luaces-Cubells (2012) examined result for children who presented 8 hour or less after fever
had started. Two studies reported results of combined tests of PCT and CRP (Guen et al., 2007;
Lacour et al., 2001).
A range of gold standard tests were then undertaken to confirm diagnosis in each child. Prevalence of
bacterial illness ranged from 0.6% to 29% across studies. Reported average age ranged from 4 days
to 36 months.
Further information is shown in the evidence tables.
Evidence profile
The GRADE profiles presented show results of included studies for the review question.
Table 8.1 – GRADE findings for comparison of different procalcitonin thresholds
Table 8.2 – GRADE findings for comparison of different C-reactive protein thresholds
Table 8.3 – GRADE findings for comparison of combined procalcitonin and C-reactive
protein thresholds
Table 8.1 GRADE findings for comparison of different procalcitonin thresholds
Number
of
studies
Number
of
children
Sensitivity
(95%
confidence
interval)
Specificity
(95%
confidence
interval)
Positive
predictive
value
(95%
confidence
interval)
Negative
predictive
value (95%
confidence
interval)
Positive
likelihood
ratio
(95%
confidence
interval)
Negative
likelihood
ratio
(95%
confidence
interval)
Quality
Bacteremia, pyelonephriitis, pneumonia, bacterial meningitis, sepsis, bone infections. Prevalence = 23%
0.5 ng/ml
1
(Andreol
a et al,
2007)
1 ng/ml
1
(Andreol
a et al,
2007)
2 ng/ml
1
(Andreol
a et al,
2007)
N = 408 73.4 (63 to
82)
N = 408 64 (53 to
74)
N = 408 48 (38 to
58)
76 (71 to
81)
90 (86 to
93)
97 (94 to
98)
48 (40 to
56) a
65 (55 to
75) a
80 (70 to
91) a
91 (87, 94) a 3.1 (2.5,
3.9) b
89 (85, 93) a 6.2 (4.4,
9.0) b
86 (82 to
90) a
13.6 (7.4 to
25.3) b
0.4 (0.2,
0.5) b
0.4 (0.3,
0.5) b
0.5 (0.4 to
0.7) b
Very
Low
Very
Low
Very
Low
159
2013 Update