RT Book, Section
A1 Nadkarni, Milan D.
A2 Cline, David M.
A2 Ma, O. John
A2 Cydulka, Rita K.
A2 Meckler, Garth D.
A2 Handel, Daniel A.
A2 Thomas, Stephen H.
SR Print(0)
ID 56273837
T1 Chapter 66. Fever and Serious Bacterial Illness in Children
T2 Tintinalli's Emergency Medicine Manual, 7e
YR 2012
FD 2012
PB The McGraw-Hill Companies
PP New York, NY
SN 978-0-07-178184-8
LK accessemergencymedicine.mhmedical.com/content.aspx?aid=56273837
RD 2024/04/23
AB Fever  is  the  most  common  chief  complaint  presenting  to  an  emergency  department  and  accounts  for  30%  of  outpatient  visits  each  year.  Early  studies  suggested  that  infants  younger  than  3  months  were  at  high  risk  of  a  serious  bacterial  illness  (SBI),  which  included  sepsis,  pyelonephritis,  pneumonia,  and  meningitis.  Current  practice  guidelines  vary  in  their  cut-offs  for  evaluation  and  treatment  strategies.  Neonates  are  clearly  at  the  highest  risk,  while  infants  in  their  second  and  third  months  of  life  gradually  transition  to  the  lower  risk  profile  of  older  infants  and  children.  The  incidence  of  bacteremia  falls  from  around  10%  among  febrile  neonates  to  approximately  0.2%  in  immunized  infants  and  children  older  than  4  months;  meningitis  risk  decreases  from  about  1%  in  the  first  month  of  life  to  <  0.1%  later  in  infancy;  the  risk  for  pyelonephritis  remains  relatively  constant  among  young  girls  with  fever,  and  gradually  decreases  among  boys  over  the  first  year  of  life.  The  individual  practitioner  must  weigh  these  risks  against  the  invasiveness  of  their  ED  evaluation  and  make  shared  decisions  with  the  family  on  the  best  approach.