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Abstract Body

BACKGROUND

Shock index, ratio heart rate/systolic blood pressure, is proposed as a new measure for haemodynamic assessment of children, but its value at first assessment in febrile children is unknown. We determined the association of the Shock Index with serious outcomes in febrile children and explored age-appropriate cut-off values.

METHODS

This analysis of the MOFICHE study (Management and Outcome of Febrile illness in Children in Europe), includes routine data of febrile children with measured blood pressure visiting 11 European EDs. The outcomes were serious bacterial infection (SBI) (clinical symptoms with identified bacteria or C-reactive protein >60 mg/L), invasive bacterial infection (IBI) (bacteraemia or bacterial meningitis) and ICU admission. The association between high Shock Index (according to Advanced Paediatric Life Support) and each of the outcomes was determined by multivariate logistic regression adjusted for age, sex, referral, comorbidity and temperature. Additionally, we calculated sensitivity, specificity, and negative and positive likelihood ratios (LR).

RESULTS

Of 5,648 children, 463 (8.2%) had SBI, 46 (0.8%) IBI, and 69 (1.2%) were admitted to the ICU. High Shock Index was related to SBI (aOR: 1.6[1.3-1.9]), IBI (aOR: 2.3[1.5-3.1]), and ICU admission (aOR:2.8 [2.1-3.5]). For the different outcomes, specificity ranged 0.93-0.94, positive LR ranged 2.2-3.1, sensitivity ranged 0.14-0.22 and negative LR ranged 0.84-0.92. No acceptable cut-off value was identified in different age groups.

CONCLUSION

High Shock Index is associated with serious outcomes in febrile children. Although Shock Index could have additional value in assessing serious outcomes in febrile children attending the ED, its rule-out value is insufficient.

Abstract Body

Background

Management of fever without source (FWS) in infants and children in the emergency department is challenging. The primary goal is to identify patients at high risk of severe infection (especially bacterial), requiring antimicrobial therapy and/or hospitalization. Recent data indicate that host transcript biomarkers can accurately discriminate bacterial from viral infection. We have adapted the Filmarray® platform to measure host response transcripts, within 1 hour from venepuncture.

Methods

PAXgene blood samples were prospectively collected from two independent cohorts, 100 patients with proven infections, aged from 1 month to 17 years from across Europe (EUCLIDS study) and 478 French patients with FWS (ANTOINE study, NCT03163628), aged 7 days to 36 months. A multivariate model was developed to predict bacterial or viral infection from the 12-transcripts measured in the Filmarray® pouch. A TRAIN-set allowed to determine the best signature that was applied to a TEST-set to assess the clinical performance.

Results

We constructed a classifier model on both cohorts. In EUCLIDS, 45 of 50 bacterial patients were accurately identified; whilst in ANTOINE, it was 146 of 152 patients. More the 12-transcript model was more specific (44%) than CRP (15%, calculated from the ANTOINE cohort), whilst sensitivity values were similar.

Conclusions

Filmarray® represents a promising technology for diagnostic tests, based on the host response. Our initial data exploring discrimination of infections in children demonstrated superior accuracy for 12-transcripts, as compared to CRP. The performances will be validated with the optimized pouch version on a larger pediatric cohort collected in the PERFORM study.

Abstract Body

Background: There are evidences that children, born with Hypoxic-ischaemic Encephalopathy (HIE), have a delay in the development of neurocognitive functions, specifically they have a deficit in executive abilities. Do they have global or specific deficit in executive abilities? The goal of this research was to examine the hypothesis that children, born with HIE, have a deficit in sustained attention.

Methods: The experimental group included 25 children aged 7-8 years (mean age = 7.4). They were born full-term with perinatal Hypoxic-ischaemic Encephalopathy. The control group included 25 typically developing children. The children from experimental and control group were matched for gender and age.

Children from both groups were assessed with 4 subtests from NEPSY (Tower, Auditory Attention and Response Set, Visual Attention, Statue) which are designed to assess the executive abilities in children.

Results: One-way ANOVA has revealed group differences (p<.05) in two subtests from NEPSY. Children with perinatal HIE have shown the weaknesses in performing Auditory Attention and Response Set and Visual Attention subtest. We did not reveal the significant differences (p<.05) in performing Tower and Statue subtest.

Conclusion: In view of the obtained results it can be assumed that the Hypoxic-ischaemic Encephalopathy has a specific (not global) negative effect on the development of executive abilities, particularly children with perinatal HIE have a deficit in sustained attention at the age of 7-8 years.