Diagnostic tests for bacterial infection from birth to 90 days
a
systematic review
a Department of
Child Health, University of Dundee, Scotland, b Department of Paediatrics, McMaster University, Hamilton,
Ontario, Canada
Correspondence to: Dr P W Fowlie, Department of Child Health, Ninewells Hospital, Dundee DD1 9SY.
Accepted 20 October 1997
AIM
To determine the clinical value
of common diagnostic tests for bacterial infection in early life.
METHODSA Medline search (1966-95) was undertaken
to identify studies that reported the assessment of a diagnostic
"test," predicting the presence or absence of bacterial infection
in infants up to 90 days of age. The quality of each selected study was
assessed using defined criteria. Data were extracted twice to minimise errors.
RESULTSSix hundred and seventy articles were
identified. Two independent investigators agreed that 194 studies met
the inclusion criteria (
= 0.85), 52 of which met primary quality
criteria; 23 studies reported data on (a) haematological indices, (b) C reactive protein evaluation, and (c) surface swab assessment. For
haematological indices, the likelihood ratios for individual tests
ranged from 20.4 (95% confidence interval 7.3 to 56.8) for a white
cell count < 7000/mm3 to 0.12 (0.04 to 0.37) for an
immature:total (I:T) white cell ratio < 0.2. For C reactive protein
evaluation, the likelihood ratios ranged from 12.56 (0.79 to 199.10)
for a value of > 6 mg/l to 0.22 (0.08 to 0.65) for a negative value.
For surface swab assessment, the likelihood ratios ranged from 33.6 (2.1 to 519.8) for a positive gastric aspirate culture to 0.08 (0.006 to 1.12) for microscopy of ear swab material that did not show any
neutrophils. Likelihood ratios for combinations of these individual
tests ranged from 10.17 (3.64 to 28.41) to 0.47 (0.22 to 1.00).
CONCLUSIONSThe methodological quality of studies
assessing the accuracy of diagnostic tests is generally poor. Even in
rigorous studies, the reported accuracy of the tests varies enormously
and they are of limited value in the diagnosis of infection in this population.
© 1998 by Archives of Disease in Childhood
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