Assessment of the utility of Yale observation scale as a predictor of bacteremia in children aged 3 months to 36 months


  • P. Sudhakar Department of Pediatrics, Institute of Child Health and Hospital for Children, Chennai, Tamil Nadu, India
  • P. Ajitha Department of Pediatrics, Rajah Muthaiah Medical College, Chidambaram, Tamil Nadu, India



Febrile children, Bacteremia, Yale observation scale


Background: The Yale observation scale (YOS) is an illness severity helps to diagnose bacteremia based on simple noninvasive clinical signs and symptoms. The aim of the present study was to assess the utility of YOS as a predictor of bacterial infection in febrile children aged 3 to 36 months.

Methods: This prospective observational study was conducted on 200 children aged 3 to 36 months presenting with fever, at the Institute of Child Health and Hospital for Children during the period from April 2016 to September 2016. Rectal temperature was taken for all children. Clinical examination was done as required based on the YOS and scores were given accordingly at the time of initial presentation of the child before invasive investigations. All the observation was assessed statistically and receiver operating characteristics (ROC) curve was performed to analyze the sensitivity of the YOS.

Results: Highly significant correlation (p=0.0001) was found to exist between the age of the child, duration of the fever, higher body temperature >104, WBC count, ANC and improved condition of patient with higher YOS. ROC curves showed that the sensitivity and specificity of YOS at the best cut off value of 14.5 was found to be 97% and 79.6% respectively.

Conclusions: YOS is very good tool for predicting bacteremia in young febrile children based on simple non-invasive clinical signs and symptoms. The findings ruled out by YOS aids in the immediate and early management of bacterial infections before the arrival of the results of the biochemical diagnostic tests.


Wright PF, Thompson J, McKee KT, Vaughn WK, Sell SH, Karzon DT. Patterns of illness in the highly febrile young child: epidemiologic, clinical and laboratory correlates. Pediatrics. 1981;67(5):694-700.

Bang A, Chaturvedi P. Yale Observation Scale for Prediction of Bacteremia in Febrile Children. Indian J Pediatrics. 2009;76(6):599-604.

Baker RC, Tiller T, Bausher JC, Belief PS, Cotton WH, Finley AH, et al. Severity of disease correlated with fever reduction in febrile infants. Pediatrics. 1989;83(6):1016-9.

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.

Al-Gwaiz LA, Babay HH. The diagnostic value of absolute neutrophil count, band count and morphologic changes of neutrophils in predicting bacterial infections. Med Princ Pract. 2007;16(5):344-7.

Jamuna R, Srinivasan S, Harish BN. Factors predicting occult bacteremia in young children. Indian J Pediatr. 2000;67(10):709-11.

Baker MD, Avner JR, Bell LM. Failure of infant observation scales in detecting serious illness in febrile, 4- to 8- weekold infants. Pediatrics 1990;85(6):1040-3.

Baraff LJ, Bass JW, Fleisher GR, Klein JO, McCracken GH Jr, Powell KR et al. Practice guideline for the management of infants and children 0 to 36 months of age with fever without source. Agency for Health Care Policy and Research. Ann Emerg Med. 1993;22(7):1198-210.

David M. Jaffe, Gary R. Fleisher. Temperature and Total White Blood Cell Count as Indicators of Bacteremia. Pediatrics. 1991;87(5):670-4.

Walia S, Haris MM, Kumble A, Soundarya M, Baliga BS, Chetan Kumar N. 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 J Pharmaceutical Clin Res. 2016;9(3):219-22.






Original Research Articles