• Claudia R Morris, Karim M Mansour, Frans A Kuypers, Tammy N Wang, Annabeth M Miller, and Sandra K Larkin.
• Children's Hospital and Research Center, Department of Emergency Medicine, Oakland, CA 94618, USA. kmansour@mail.cho.org
• Am J Emerg Med. 2011 Nov 1;29(9):1163-8.

BackgroundFever is a common presenting complaint to the emergency department (ED), and the evaluation of the febrile child remains a challenging task.ObjectiveThe aim of this study was to examine the relationship between secretory phospholipase A2 (sPLA2) and infection in febrile children.MethodsA prospective convenience sample of children presenting with fever to an urban pediatric ED were studied. Blood and urine cultures, a complete blood count, and serum concentrations of sPLA2 were obtained, and patients were compared based on their final diagnosis of either a viral or bacterial infection.ResultsIn the 76 patients enrolled, 60 were diagnosed with a viral infection, 14 with a bacterial infection, 1 with Kawasaki disease, and 1 with acute lymphoblastic leukemia. The difference in the serum concentration of sPLA2 in patients with viral infections (22 ± 34 ng/mL) versus those with bacterial infections (190 ± 179 ng/mL) was statistically significant (P < .0001). Receiver operator characteristic curve analysis revealed that sPLA2 was more accurate at predicting bacterial infection (area under the curve = 0.89) than the total white blood cell count (area under the curve = 0.71) and that a value of more than 20 ng/mL had a sensitivity of 93%, specificity of 67%, positive predictive value of 39%, and negative predictive value of 97%.ConclusionSecretory phospholipase A2 differs significantly in children with viral versus bacterial infection and seems to be a reliable screening test for bacterial infection in febrile children.Copyright © 2011 Elsevier Inc. All rights reserved.

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