Aim: To compare diagnostic accuracy of procalcitonin for early diagnosis of s erious bacterial infection (SBI) in children presenting with fever and no focus of infection. Methods: Prospective, observational study involving 72 children (1 - 36 mo) presenting to the paediatric units of two university hospitals. All ch ildren had blood cultures, urine cultures, white blood cell counts (WBC), chest X- ray, C- reactive protein (CRP)- and procalcitonin (PCT) done at presentati on. Results: Eight (11.1% ) children had SBI (1 pneumonia, 2 meningitis, 4 sept icaemia/ occult bacteraemia, 2 pyelonephritis), 19 (26.4% ) had possible bacter ial infection (received antibiotic treatment, but no organism grown) and 45 (62. 5% ) had viral or possible viral infection (virus isolated and/or uneventful re covery without antibiotics). PCT (> 2 ng/l), CRP(>50 mg/l) and McCarthy’s scor e ( 5 0 mg/l), PCT ( > 2 ng/l), white blood cells ( > 15 × 109/l) and McCarthy’s score ( < 9)were 0.36/2.4, 0.58/ 3.5, 0.94/1.1 and 0.19/2.7, respectively. A com bination of PCT, CRP and WBC generated a positive likelihood ratio of 10.6, chan ging the post- test probability to 54% . Conclusion: For early diagnosis of SB I in children presenting with fever and no focus of infection, the diagnostic ut ility of procalcitonin is similar to the traditional markers infection and clini cal scoring. While a low procalcitonin level cannot be used to exclude SBI in th is population, a combination of PCT, CRP and WBC may be more useful in predictin g SBI.
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