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Abstract
Background Early differentiation of febrile young infants with from those without serious infections (SIs) remains a diagnostic challenge. We sought to (1) compare vital signs and heart rate variability (HRV) parameters between febrile infants with versus without SIs, (2) assess the performance of HRV and vital signs with reference to current triage tools and (3) compare HRV and vital signs to HRV, vital signs and blood biomarkers, when predicting for the presence of SIs.
Methods Using a prospective observational design, we recruited patients <3 months old presenting to a tertiary paediatric ED in Singapore from December 2018 through November 2019. We obtained patient demographic characteristics, triage assessment (including the Severity Index Score (SIS)), HRV parameters (time, frequency and non-linear domains) and laboratory results. We performed multivariable logistic regression analyses to predict the presence of an SI, using area under the curve (AUC) with the corresponding 95% CI to assess predictive capability.
Results Among 203 infants with a mean age of 38.4 days (SD 27.6), 67 infants (33.0%) had an SI. There were significant differences in the time, frequency and non-linear domains of HRV parameters between infants with versus without SIs. In predicting SIs, gender, temperature and the HRV non-linear parameter Poincaré plot SD2 (AUC 0.78, 95% CI 0.71 to 0.84) performed better than SIS alone (AUC 0.61, 95% CI 0.53 to 0.68). Model performance improved with the addition of absolute neutrophil count and C reactive protein (AUC 0.82, 95% CI 0.76 to 0.89).
Conclusion An exploratory prediction model incorporating HRV and biomarkers improved prediction of SIs. Further research is needed to assess if HRV can identify which young febrile infants have an SI at ED triage.
Trial registration number NCT04103151.
- paediatrics
- paediatric emergency medicine
- infection
- ECG
- clinical assessment
- effectiveness
Data availability statement
Data are available upon reasonable request. Individual participant data that underlie the results reported in this article, after deidentification (text, tables, figures, and appendices) can be shared with researchers who provide a methodologically sound proposal. Proposals should be directed to Chong.Shu-Ling@kkh.com.sg.
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Data availability statement
Data are available upon reasonable request. Individual participant data that underlie the results reported in this article, after deidentification (text, tables, figures, and appendices) can be shared with researchers who provide a methodologically sound proposal. Proposals should be directed to Chong.Shu-Ling@kkh.com.sg.
Footnotes
Handling editor Roland C Merchant
Presented at Prior abstract submission: 1567: Utility of Heart Rate Variability in the Triage of Febrile Infants, Critical Care Medicine: January 2020 - Volume 48 - Issue 1 - p 759 doi: 10.1097/01.ccm.0000648176.68927.0c
Contributors S-LC and GY-KO conceptualised and designed the study, coordinated and supervised data collection, drafted the initial manuscript and reviewed and revised the manuscript. JCA developed the analytical plan, carried out the analysis and reviewed and revised the manuscript. JHL, PM and NL reviewed and approved the design of the study, reviewed and revised the manuscript. RP and GZXK designed the data collection instruments, collected data, and reviewed and revised the manuscript. OM supervised the study, approved the design, reviewed and revised the manuscript. All authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.
Funding Supported by National Medical Research Council (Singapore) <NMRC/MOH-000158-00> to S-LC.
Competing interests None declared.
Provenance and peer review Not commissioned; externally peer reviewed.
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