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Identifying Children at Risk of Malignant Bordetella pertussis Infection

Ganeshalingham, Anusha MBChB, FCICM1; McSharry, Brent MBBS, FCICM1; Anderson, Brian MBChB, FCICM1; Grant, Cameron MBChB, FRACP2; Beca, John MBChB, FCICM1

Pediatric Critical Care Medicine: January 2017 - Volume 18 - Issue 1 - p e42-e47
doi: 10.1097/PCC.0000000000001013
Online Clinical Investigations
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Objective: To identify factors associated with malignant pertussis.

Design: A retrospective case notes review from January 2003 to August 2013. Area under the receiver-operator characteristic curve was used to determine how well vital sign and white cell characteristics within 48 hours of hospital presentation identified children with malignant pertussis.

Setting: The national children’s hospital in Auckland, New Zealand.

Patients: One hundred fifty-two children with pertussis.

Measurements and Main Results: There were 152 children with confirmed pertussis identified, including 11 children with malignant pertussis. The area under the receiver-operator characteristic curve was 0.88 (95% CI, 0.78–0.97) for maximum heart rate. The optimal cut-point was 180 beats/min, which predicted malignant pertussis with a sensitivity of 73% and a specificity of 91%. The area under the receiver-operator characteristic curve was 0.92 (95% CI, 0.81–1.0) for absolute neutrophil count, 0.85 (95% CI, 0.71–0.99) for total WBC count, 0.80 (95% CI, 0.63–0.96) for neutrophil-to-lymphocyte ratio, and 0.77 (95% CI, 0.58–0.92) for absolute lymphocyte count. All children with malignant pertussis had one or more of heart rate greater than 180 beats/min, total WBC count greater than 25 × 109/L, and neutrophil-to-lymphocyte ratio greater than 1.0 with an area under the receiver-operator characteristic curve of 0.96 (95% CI, 0.91–1.0) for a multivariate model that included these three variables.

Conclusions: Clinical predictors of malignant pertussis are identifiable within 48 hours of hospital presentation. Early recognition of children at risk of malignant pertussis may facilitate early referral to a PICU for advanced life support and selection for trials of investigational therapies.

1Pediatric Intensive Care Unit, Starship Children’s Hospital, Auckland, New Zealand.

2Department of General Pediatrics, Starship Children’s Hospital, Auckland, New Zealand.

The authors have disclosed that they do not have any potential conflicts of interest.

For information regarding this article, E-mail: anushag@adhb.govt.nz

Copyright © 2016 by the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies