Impact of the Lab-Score on Antibiotic Prescription Rate in XXXX with Fever without Source: A Randomized Controlled Trial.

@entity1 @entity1904 @entity2348 @entity221 @entity1851
BACKGROUND: The Lab-score, based on the combined determination of @entity1904 , @entity1851 and urinary dipstick results, has been shown accurate in detecting serious @entity2348 (SBI) in @entity1 with @entity221 ( @entity221 ) on retrospective cohorts. We aimed to prospectively assess the utility of the Lab-score in safely decreasing antibiotic prescriptions in @entity1 with @entity221 and to determine its diagnostic characteristics compared to common SBI biomarkers. METHODS: Randomized controlled trial in @entity1 7 days to 36 months old with @entity221 , allocated either to the Lab-score group (Lab-score reported, blinded WBC count) or to the control group (WBC, bands and @entity1851 determined, blinded @entity1904 and Lab-score), followed up until recovery. Demographic data, antibiotic prescription rate, admission rate and diagnostic properties of the Lab-score were analyzed. RESULTS: 271 @entity1 were analyzed. No statistically significant difference concerning antibiotic prescription rate was observed: 41.2% (54 of 131) in the Lab-score group and 42.1% (59 of 140) in the control group (p=1.000). If recommendations based on the Lab-score had been strictly applied, a hypothetical 30.6% treatment rate would have been encountered, compared to the overall 41.7% observed rate (p=0.0095). A Lab-score >= 3 showed the following characteristics: sensitivity 85.1% (95% CI: 76.5-93.6%), specificity 87.3% (95% CI: 82.7-91.8%), positive predictive value 68.7% (95% CI: 58.7-78.7%), negative predictive value 94.1% (95% CI: 91.5-97.9%), positive and negative likelihood ratios: 6.68 and 0.17 respectively. Area under the receiver operating characteristic curve was best for the Lab-score (0.911, 95% CI: 0.871-0.950). DISCUSSION: No difference regarding antibiotic treatment rate was observed when using the Lab-score, due to lack of adherence to the related recommendations. However, if strictly followed, a significant 26.5% reduction of antibiotic prescriptions would have been encountered. Medical education needs to be reinforced in order to observe rather than treat low-risk well-appearing @entity1 with @entity221 . TRIAL REGISTRATION: ClinicalTrials.gov NCT02179398.
