Yale observation scale for bacterial infection in febrile children


  • Shiwani Mangla Department of Paediatrics, Geetanjali Medical College and Hospital, Udaipur, Rajasthan, India
  • Hemant Jain Department of Paediatrics, Geetanjali Medical College and Hospital, Udaipur, Rajasthan, India




Bacteremia, Febrile children, Serious bacterial infection, Yale observation scale


Background: Sepsis is one of the leading causes of mortality in children under 5 years by UNICEF statistics which is difficult to diagnose because of nonspecific initial clinical presentation and potential for rapid deterioration. In this regard use of Yale Observation Scale assists in early recognition of serious bacterial infection than other laboratory investigation as it is simple, quick, easy to apply and cost-effective bed side scale.

Methods: All eligible young febrile infants and children were consecutively enrolled in the study. Axillary temperatures of the cases were documented. Yale observation scoring was done. Blood sample were sent for culture and sensitivity. Colonies were identified morphologically by Gram stain and biochemically. The collected data was analyzed using ROC curve for finding cut off scores of Yale Observation Scale for prediction of severe bacterial illness and final outcome. Statistical analysis was performed using the Statistical Packages for Social Sciences (SPSS) version 14 for MS Window.

Results: Bacteremia was found in 23(15.3%) out of total 150 young febrile children enrolled in the present study. It shows that in lower YOS score blood culture was sterile and in higher YOS score blood culture was positive for bacteremia, which is statistically significant with p value (<0.05). As per ROC curve analyses the best cut off value of YOS for prediction of bacteremia was 17.5 with sensitivity 91.3%, specificity 81.9%, PPV 47.7% and NPV of 98.1%.

Conclusions: YOS of  >17.5 has a good predictive ability for prediction of bacteraemia in young febrile children.


Nelson DS, Walsh K, Fleisher GR. Spectrum and frequency of pediatric illness presenting to a general community hospital emergency department. Pediatr. 1992 Jul 1;90(1):5-10.

Krauss BS, Harakal TH, Fleisher GR. The spectrum and frequency of illness presenting to a pediatric emergency department. Pediatr Emerg Care. 1991 Apr;7(2):67-71.

Health Advice for Children Traveling. In: Kliegman, Stanton, Geme ST, Schor, Behrman. Nelson textbook of pediatrics. 19th ed. New Delhi, Elsevier; 2011: 896-897.

Dellinger RP, Levy MM. Surviving sepsis campaign: international guidelines for management of severe sepsis and septic shock: 2012. Critic Care Med. 2013;41:580-637.

Bang A, Chaturvedi P. Yale Observation Scale for prediction of bacteremia in febrile children. Ind J Pediatr. 2009 Jun 1;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. Pediatr. 1982 Nov 1;70(5):802-9.

Shagun Walia HM, Kumble A, Soundarya M, Baliga B, Kumar C. 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 Pharm Clin Res. 2016;9(3):219-22.

McCarthy PL, Lembo RM, Fink HD, Baron MA, Cicchetti DV. Observation, history, and physical examination in diagnosis of serious illnesses in febrile children ≤24 months. J Pediatr. 1987 Jan 1;110(1):26-30.

Bonadio WA. The history and physical assessments of the febrile infant. Pediatr Clin North Am. 1998 Feb 1;45(1):65-77.

Nigrovic LE, Mahajan PV, Blumberg SM, et al. The Yale Observation Scale Score and the Risk of Serious Bacterial Infections in Febrile Infants. Pediatrics. 2017;140(1):e20170695.

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

Waskerwitz S, Berkelhamer JE. Outpatient bacteremia: Clinical findings in children under two years with initial temperatures of 39.5 C or higher. J Pediatr. 1981 Aug 1;99(2):231-3.

Liu CH, Lehan C, Speer ME, Smith EB, Gutgesell ME, Fernbach DJ, et al. Early detection of bacteremia in an outpatient clinic. Pediatr. 1985 May 1;75(5):827-31.

Alpern ER, Alessandrini EA, Bell LM, Shaw KN, McGowan KL. Occult bacteremia from a pediatric emergency department: current prevalence, time to detection, and outcome. Pediatr. 2000;106(3):505-11.

Kansakar P, Shrestha PS, Shrestha M. Efficacy of Yale observation scale to detect serious bacterial infection in febrile children aged one to 36 months. J Patan Acad Health Sci. 2014;1(2):23-6.

Baker MD, Avner JR, Bell LM. Failure of infant observation scales in detecting serious illness in febrile, 4-to 8-week-old infants. Pediatr. 1990 Jun 1;85(6):1040-3.

Thapar K, Malhotra P, Singh I. Yale Observation Score for Prediction of Critical Illness in 3-36 Months Old Febrile Children. Inter J Sci Res. 2015;6(1).

Sudhakar P, Ajitha P. Assessment of the utility of Yale observation scale as a predictor of bacteremia in children aged 3 months to 36 months. Inter J Contemp Pediatr. 2019 Mar;6(2):559.

Bharti B, Bharti S, Verma V. Role of Acute Illness Observation Scale (AIOS) in managing severe childhood pneumonia. Ind J Pediatr. 2007;74(1):27-32.

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 Nov;42(11):2409.






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