Application of the Rochester Criteria to Identify Febrile Infants With Bacteremia and Meningitis

Paul L. Aronson, Russell J. McCulloh, Joel S. Tieder, Lise E. Nigrovic, Rianna C. Leazer, Elizabeth R Alpern, Elana A. Feldman, Fran Balamuth, Whitney L. Browning, Mark I. Neuman

Research output: Contribution to journalArticle

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Abstract

Objectives: The Rochester criteria were developed to identify febrile infants aged 60 days or younger at low-risk of bacterial infection and do not include cerebrospinal fluid (CSF) testing. Prior studies have not specifically assessed criteria performance for bacteremia and bacterial meningitis (invasive bacterial infection). Our objective was to determine the sensitivity of the Rochester criteria for detection of invasive bacterial infection. Methods: Retrospective cohort study of febrile infants aged 60 days or younger with invasive bacterial infections evaluated at 8 pediatric emergency departments from July 1, 2012, to June 30, 2014. Potential cases were identified from the Pediatric Health Information System using International Classification of Diseases, Ninth Revision diagnosis codes for bacteremia, meningitis, urinary tract infection, and fever. Medical record review was then performed to confirm presence of an invasive bacterial infection and to evaluate the Rochester criteria: medical history, symptoms or ill appearance, results of urinalysis, complete blood count, CSF testing (if obtained), and blood, urine, and CSF culture. An invasive bacterial infection was defined as growth of pathogenic bacteria from blood or CSF culture. Results: Among 82 febrile infants aged 60 days or younger with invasive bacterial infection, the sensitivity of the Rochester criteria were 92.7% (95% confidence interval [CI], 84.9%-96.6%) overall, 91.7% (95% CI, 80.5%-96.7%) for neonates 28 days or younger, and 94.1% (95% CI, 80.9%-98.4%) for infants aged 29 to 60 days old. Six infants with bacteremia, including 1 neonate with bacterial meningitis, met low-risk criteria. Conclusions: The Rochester criteria identified 92% of infants aged 60 days or younger with invasive bacterial infection. However, 1 neonate 28 days or younger with meningitis was classified as low-risk.

LanguageEnglish (US)
Pages22-27
Number of pages6
JournalPediatric emergency care
Volume35
Issue number1
DOIs
StatePublished - Jan 1 2019

Fingerprint

Bacteremia
Meningitis
Bacterial Infections
Fever
Cerebrospinal Fluid
Bacterial Meningitides
Newborn Infant
Confidence Intervals
Pediatrics
Health Information Systems
Urinalysis
Blood Cell Count
International Classification of Diseases
Urinary Tract Infections
Medical Records
Hospital Emergency Service
Cohort Studies
Retrospective Studies
Urine
Bacteria

Keywords

  • Rochester criteria
  • bacteremia
  • febrile infant
  • fever
  • invasive bacterial infection
  • meningitis

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Emergency Medicine

Cite this

Aronson, P. L., McCulloh, R. J., Tieder, J. S., Nigrovic, L. E., Leazer, R. C., Alpern, E. R., ... Neuman, M. I. (2019). Application of the Rochester Criteria to Identify Febrile Infants With Bacteremia and Meningitis. Pediatric emergency care, 35(1), 22-27. https://doi.org/10.1097/PEC.0000000000001421
Aronson, Paul L. ; McCulloh, Russell J. ; Tieder, Joel S. ; Nigrovic, Lise E. ; Leazer, Rianna C. ; Alpern, Elizabeth R ; Feldman, Elana A. ; Balamuth, Fran ; Browning, Whitney L. ; Neuman, Mark I. / Application of the Rochester Criteria to Identify Febrile Infants With Bacteremia and Meningitis. In: Pediatric emergency care. 2019 ; Vol. 35, No. 1. pp. 22-27.
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Aronson, PL, McCulloh, RJ, Tieder, JS, Nigrovic, LE, Leazer, RC, Alpern, ER, Feldman, EA, Balamuth, F, Browning, WL & Neuman, MI 2019, 'Application of the Rochester Criteria to Identify Febrile Infants With Bacteremia and Meningitis', Pediatric emergency care, vol. 35, no. 1, pp. 22-27. https://doi.org/10.1097/PEC.0000000000001421

Application of the Rochester Criteria to Identify Febrile Infants With Bacteremia and Meningitis. / Aronson, Paul L.; McCulloh, Russell J.; Tieder, Joel S.; Nigrovic, Lise E.; Leazer, Rianna C.; Alpern, Elizabeth R; Feldman, Elana A.; Balamuth, Fran; Browning, Whitney L.; Neuman, Mark I.

In: Pediatric emergency care, Vol. 35, No. 1, 01.01.2019, p. 22-27.

Research output: Contribution to journalArticle

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AU - Tieder, Joel S.

AU - Nigrovic, Lise E.

AU - Leazer, Rianna C.

AU - Alpern, Elizabeth R

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