Early identification of infectious complications in pediatric burn patients: a prospective cohort study

OBJECTIVE: To assess early identification of infectious complications in pediatric burn patients and to evaluate the performance of the Intensive Care Infection Score (ICIS) in comparison with conventional inflammatory biomarkers. DESIGN: Prospective observational cohort study. SETTING: Tertiary pediatric burn intensive care unit. PATIENTS: Children admitted within 24 h of acute burn injury and requiring intensive care for ≥ 3 days. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Sixty-nine children were enrolled; 18 (26%) experienced at least one infectious episode. Infection was defined using a composite reference standard that included clinical diagnosis, microbiological findings, and initiation of targeted antibiotic therapy. ICIS was calculated from extended complete blood count parameters obtained during routine clinical care. Receiver operating characteristic analysis demonstrated higher discriminative performance of ICIS compared with C-reactive protein and procalcitonin in this cohort. The area under the curve for ICIS was 0.93, compared with 0.71 and 0.72 for C-reactive protein and procalcitonin, respectively. At a cutoff value of ≥4, ICIS demonstrated very high sensitivity and negative predictive value in this cohort, with no false-negative observations, and a specificity of 0.70. CONCLUSIONS: In pediatric burn patients, ICIS demonstrated high diagnostic accuracy in this cohort and improved discrimination compared with C-reactive protein and procalcitonin, particularly as a rule-out test. These findings provide novel evidence on the application of ICIS in a pediatric burn population. As ICIS is derived from routine blood counts without additional sampling or direct laboratory cost, it may represent a practical tool to support early clinical decision-making and antimicrobial stewardship in pediatric burn care.