• Shagun Walia Manipal university, Karnataka
  • Haris M M Manipal University
  • Ali Kumble Manipal University
  • Soundarya Mahalingam Manipal University
  • B Shantharam Baliga Manipal University
  • Chetan Kumar Nanjegowda Manipal University




Objectives: The objective of the study was to assess predictability of bacteremia in febrile children in the age group of 3-36 months by application of
Yale observation scale (YOS) and to predict clinical course during hospital stay and final outcome by YOS.
Methods: A hospital-based cross-sectional study was carried out at Kasturba Medical College, Mangalore, Karnataka, for a period of 2 years
(September 2013-September, 2015) in 100 febrile children in the age group of 3-36 months with probable infectious etiology admitted in ward/PICU.
Children with any non-infectious causes of fever (vaccination, autoimmune, and immunodeficiency disorder) were excluded from the study. Cases
were selected by simple random sampling. The primary study outcome was bacteremia based on positivity on blood culture and sensitivity sample
drawn at admission. Secondary outcomes are clinical course in the hospital, use of antibiotics, need for mechanical ventilation, hospital stay, and
Results: 100 cases were included in the study out of which 18 cases were bacteremic with a mean YOS of 26 (non-bacteremic - 11), mean hospital
stay 19.5 days (non-bacteremic - 12 days). All 18 bacteremic children had YOS ≥20, but YOS ≥20 had 8 false positives cases. There was no significant
interobserver variability in YOS assessment (Cronbach's alpha - 0.993 showing good correlation with intraclass correlation coefficient - 0.986).
Higher YOS scores had good sensitivity, specificity, positive and negative likelihood ratios, and area under curve for prediction of bacteremia at
YOS >20 (100%, 90.2%, 10.2, 0.00, and 0.970), need for mechanical ventilation at YOS >21 (100%, 91.7%, 12.04, 0.00, and 0.969), need for scaling up
antibiotics at YOS >21 (70.4%, 94.4%, 12.5, 0.31, and 0.822), and mortality at YOS >21 (90.9%, 85.4%, 6.2, 0.106, 0.878).
Conclusion: YOS is a good tool to rule out bacteremia and to prognosticate the clinical course at the first visit. This simple scale can be of value in
monitoring admitted patients for deteriorating clinical state and for assessing the need for referral to higher centers for further management.
Keywords: Yale observation scale, Bacteremia, Febrile patients.

Author Biographies

Shagun Walia, Manipal university, Karnataka

Department of Pediatrics, Post Graduate

Haris M M, Manipal University

Department of Pediatrics, Assistant Professor

Ali Kumble, Manipal University

Department of Pediatrics, Professor

Soundarya Mahalingam, Manipal University

Department of Pediatrics, Associate Professor

B Shantharam Baliga, Manipal University

Department of Pediatrics, Professor

Chetan Kumar Nanjegowda, Manipal University

Department of Pediatrics, Post Graduate


UNICEF-2013 Statistical Snapshot Child Mortality. http://www.who.int/healthinfo/global_burden_disease/ChildCOD_method_2000_2013.pdf.

Bang A, Chaturvedi P. Yale observation scale for prediction of bacteremia in febrile children. Indian J Pediatr 2009;76(6):599-604.

McCarthy PL, Sharpe MR, Spiesel SZ, Dolan TF, Forsyth BW, DeWitt TG, et al. Observation scales to identify serious illness in febrile children. Pediatrics 1982;70(5):802-9.

Weiss SL, Fitzgerald JC, Balamuth F, Alpern ER, Lavelle J, Chilutti M, et al. Delayed antimicrobial therapy increases mortality and organ dysfunction duration in pediatric sepsis. Crit Care Med 2014;42(11):2409-17.

Thompson M, Van den Bruel A, Verbakel J, Lakhanpaul M, Haj-Hassan T, Stevens R, et al. Systematic review and validation of prediction rules for identifying children with serious infections in emergency departments and urgent-access primary care. Health Technol Assess 2012;16(15):1-99.

Thayyil S, Shenoy M, Hamaluba M, Gupta A, Frater J, Verber IG. Is procalcitonin useful in early diagnosis of serious bacterial infections in children? Acta Paediatr 2005;94(2):155-8.

Andreola B, Bressan S, Callegaro S, Liverani A, Plebani M, Da Dalt L.Procalcitonin and C-reactive protein as diagnostic markers of severe bacterial infections in febrile infants and children in the emergency department. Pediatr Infect Dis J 2007;26(8):672-7.

Baker MD, Avner JR, Bell LM. Failure of infant observation scales in detecting serious illness in febrile, 4 - To 8-week-old infants. Pediatrics 1990;85:1040-3.

Galetto-Lacour A, Zamora SA, Gervaix A. Bedside procalcitonin and C-reactive protein tests in children with fever without localizing signs of infection seen in a referral center. Pediatrics 2003;112:1054-60.

Hsiao AL, Chen L, Baker MD. Incidence and predictors of serious bacterial infections among 57 - To 180-day-old infants. Pediatrics 2006;117(5):1695-701.

Lacour AG, Gervaix A, Zamora SA, Vadas L, Lombard PR, Dayer JM, et al. Procalcitonin, IL-6, IL-8, IL-1 receptor antagonist and C-reactive protein as identificators of serious bacterial infections in children with fever without localising signs. Eur J Pediatr 2001;160(2):95-100.

Van den Bruel A, Haj-Hassan T, Thompson M, Buntinx F, Mant D. Diagnostic value of clinical features at presentation to identify serious infection in children in developed countries: A systematic review. Lancet 2010;375(9717):834-45.

Centers for Disease Control and Prevention. Epidemiology and Prevention of Vaccine-Preventable Diseases. 13th ed. Washington, D.C: Centers for Disease Control and Prevention; 2014.

Harris JB, Gacic-Dobo M, Eggers R, Brown DW, Sodha SV. Global routine vaccination coverage, 2013. MMWR 2014;63(46):1055-8.

UNICEF India 2013 Health Related Statistics Report. Downloadable at; http://www.unicef.org/infobycountry/india_statistics.html.



How to Cite

Walia, S., H. M. M, A. Kumble, S. Mahalingam, B. S. Baliga, and C. K. Nanjegowda. “YALE OBSERVATION SCALE AS A PREDICTOR OF BACTEREMIA AND FINAL OUTCOME IN 3-36 MONTHS OLD FEBRILE CHILDREN ADMITTED IN TERTIARY HEALTH CENTRES: A HOSPITAL-BASED CROSS-SECTIONAL STUDY”. Asian Journal of Pharmaceutical and Clinical Research, vol. 9, no. 9, Dec. 2016, pp. 219-22, doi:10.22159/ajpcr.2016.v9s3.11707.



Original Article(s)