Decision Tree Analysis as a Preliminary Evidence‐Based Tool for Identifying the Syndrome of Undifferentiated Recurrent Fever in Children Compared With Hereditary Recurrent Fevers and Periodic Fever, Aphthosis, Pharyngitis, and Adenitis Syndrome
Authors' conclusion
The study shows the possibility of achieving evidence-based criteria that can classify SURF at least with respect to the main HRF and PFAPA syndrome
Study context
- Population
- Children with syndrome of undifferentiated recurrent fevers (SURF) at a single tertiary referral centre; disease controls with hereditary recurrent fever (HRF) or periodic fever, aphthosis, pharyngitis, and adenitis (PFAPA) syndrome from the Eurofever classification criteria analysis123 in external validation cohort
- Comparison
- Decision tree vs logistic regression models, with and without genetic data, to classify SURF vs HRF and PFAPA syndrome
- SURFn = 112
- Outcome
- Classification of patients with SURF by evidence-based criteria
Methodological detailssingle tertiary referral centre, decision tree analysis, logistic regression model, training set and internal test set (random split), external validation in four other centres
- Single tertiary referral centre
- Decision tree analysis
- Logistic regression model
- Training set and internal test set (random split)
- External validation in four other centres
Performance
As reported in the abstract
Classification of SURF
Decision tree, clinical and genetic data: SURF patients identified
91%
Decision tree, clinical variables only: SURF patients identified
up to 88%
Logistic regression including genetic tests: overall accuracy
89.2%
95% CI 81.1–94.7
Logistic regression, clinical manifestations only: overall accuracy
66.7%
95% CI 56.1–76.1
Further findings
External validation, criteria including genetic tests: AUC (ROC)
- Decision tree model
- 96.3%
- Logistic regression model
- 88.0%
- External validation cohort, 123 patients from four other centres
Original publication
Decision Tree Analysis as a Preliminary Evidence‐Based Tool for Identifying the Syndrome of Undifferentiated Recurrent Fever in Children Compared With Hereditary Recurrent Fevers and Periodic Fever, Aphthosis, Pharyngitis, and Adenitis Syndrome. Arthritis Rheumatol. Published 17 February 2026. doi:10.
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