Utility of the yale observation scale in predicting bacteremia in febrile children aged 3–36 months: a hospital-based prospective observational study.
DOI:
https://doi.org/10.51168/dc63he64Keywords:
Yale Observation Scale, bacteremia, febrile child, pediatric infection, screening toolAbstract
Background:
Early identification of bacteremia in febrile children remains a major clinical challenge, particularly in resource-limited settings. The Yale Observation Scale (YOS) is a simple bedside clinical tool used to assess illness severity in children.
Objective:
To evaluate the diagnostic performance of YOS in predicting bacteremia among febrile children aged 3–36 months.
Methods:
This hospital-based prospective observational study was conducted over 12 months at the Department of Pediatrics, Barpeta Medical College , Assam, India. A total of 150 children presenting with fever ≥38°C without an identifiable source were enrolled using consecutive sampling. Clinical assessment using YOS was performed at admission, followed by laboratory investigations, including a complete blood count, absolute neutrophil count, and a blood culture. Receiver operating characteristic (ROC) curve analysis was used to determine the optimal YOS cutoff for predicting bacteremia.
Results:
Among the 150 children included, 56.7% were females and 43.3% were males. Blood culture positivity was observed in 21.3% of cases. Higher YOS scores were significantly associated with bacteremia, elevated white blood cell count, prolonged fever, longer hospital stay, and mortality (p<0.05). ROC analysis demonstrated that a YOS cutoff value of 14.5 had a sensitivity of 97% and specificity of 79.6% for predicting bacteremia. All children with YOS scores ≥25 had positive blood cultures and poor clinical outcomes.
Conclusion:
YOS is a sensitive and practical bedside screening tool for identifying febrile children at increased risk of bacteremia. However, because of its moderate specificity, it should be used together with laboratory investigations for definitive diagnosis.
Recommendation:
YOS may be incorporated into early pediatric triage protocols in resource-limited settings to facilitate prompt identification and management of high-risk children.
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Copyright (c) 2026 Dilip Sai Babu D, Nazrul Islam Barbhuiya, Rehana Sultana (Author)
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