Clinical Policy for Well-Appearing Infants and Children Younger Than 2 Years of Age Presenting to the Emergency Department With Fever

Eskin, Barnet; Bakes, Katherine; Brown, Michael D.; Brecher, Deena; Byyny, Richard L.; Diercks, Deborah B.; Gemme, Seth R.; Gerardo, Charles J.; Godwin, Steven A.; Hahn, Sigrid A.; Hatten, Benjamin W.; Haukoos, Jason S.; Ingalsbe, Graham S.; Kaji, Amy H.; Kwok, Heemun; Lo, Bruce M.; Mace, Sharon E.; Nazarian, Devorah J.; Proehl, Jean A.; Promes, Susan B.; Shah, Kaushal; Shih, Richard D.; Silvers, Scott M.; Smith, Michael D.; Thiessen, Molly E.W.; Tomaszewski, Christian; Valente, Jonathan H.; Wall, Stephen P.; Wolf, Stephen J.; Cantrill, Stephen V.; O’Connor, Robert E.; Whitson, Rhonda R.; Mitchell, Mary Anne

doi:10.1016/j.annemergmed.2016.01.042

Cited by 21 publications

(20 citation statements)

References 57 publications

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“…The mortality rate associated with bacteremia may be as high as 30% [11]. The clinical management of children older than 3 months of age, who present in the PED with fever, is still controversial [10,12]. There is great heterogeneity in the evaluation and the management practices of this group of patients, including the need for a complete blood count (CBC), measurement of C-reactive protein (CRP) and blood culture (BC) [2][3][4]6,7,13].…”

Section: Introductionmentioning

confidence: 99%

The Outcome of Blood Cultures in Febrile Children Presenting at theEmergency Department

Salameh¹,

Gz²,

Alkume³

et al. 2016

Neonat Pediatr Med

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Background: An unknown number of children who attend an Emergency Department may have a serious underlying, systemic infection as a cause of their fever. Blood culture (BC) remains the gold standard approach to establish the diagnosis and presence of pathogens in a child with a suspected, serious bacterial infection. This study investigated the proportion of positive blood cultures and the correlation with basic laboratory investigations (Creactive protein, white blood cell count, and absolute neutrophil count), prescription of antibiotics in patients visiting a pediatric emergency department in a primary hospital

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Section: Introductionmentioning

confidence: 99%

The Outcome of Blood Cultures in Febrile Children Presenting at theEmergency Department

Salameh¹,

Gz²,

Alkume³

et al. 2016

Neonat Pediatr Med

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“…Initial patient care is provided by pediatric or emergency medicine residents under the supervision of board‐certificated emergency medicine physicians or pediatricians . The ED practice guidelines used at the present hospital, which were developed on the basis of previous studies and recommendations, provide a standardized management protocol for febrile young infants …”

Section: Methodsmentioning

confidence: 99%

“…11 The ED practice guidelines used at the present hospital, which were developed on the basis of previous studies and recommendations, provide a standardized management protocol for febrile young infants. 1,6…”

Section: Settingmentioning

confidence: 99%

“…In patients <90 days of age, increased body temperature is a matter of great concern. A fever in these patients requires emergency medical treatment due to the significant risk of serious bacterial infection (SBI) . Several clinical practice guidelines recommend a thorough investigation, including laboratory and blood and urine culture, X‐ray, and rapid viral tests to rule out serious infection SBI in febrile infants.…”

mentioning

confidence: 99%

“…A fever in these patients requires emergency medical treatment due to the significant risk of serious bacterial infection (SBI). [1][2][3][4] Several clinical practice guidelines recommend a thorough investigation, including laboratory and blood and urine culture, X-ray, and rapid viral tests to rule out serious infection SBI in febrile infants. Such an exhaustive battery of tests, however, can be expensive.…”

mentioning

confidence: 99%

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Predicting serious bacterial infection in febrile young infants utilizing body temperature

Nomura

Ihara

Sakakibara³

et al. 2019

Pediatrics International

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Background Febrile young infants have a high risk of serious infection. Although measuring vital sign parameters can serve as a rapid and effective assessment in these patients, their predictive value for serious bacterial infection (SBI) has not been fully investigated. Methods This retrospective observational study enrolled febrile (>38.0°C) infants aged <90 days at the time of presentation. Data from the emergency room triage database at Tokyo Metropolitan Children's Medical Center for the period 1 November 2011–30 November 2013, were reviewed. Variables included patient age, gender, and vital sign data, including body temperature, pulse rate, oxygen saturation, definitive diagnosis, and disposition. Results Two hundred and sixty‐nine patients were included, with a mean age of 55 days, and 158 (58.7%) were male. Of the total, 43 patients had an SBI. On logistic regression, body temperature ≥38.5°C (OR, 2.80; 95%CI: 1.37–5.74) was a significant predictor of SBI. Conclusion High‐grade fever was found to be a significant predictor of SBI in febrile young infants.

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Ambulatory Follow-up and Outcomes Among Medicare Beneficiaries After Emergency Department Discharge

et al. 2020

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Key Points Question How often do Medicare beneficiaries have an ambulatory follow-up visit after discharge from the emergency department, and is ambulatory follow-up associated with postdischarge outcomes? Findings In this cohort study of 9 470 626 emergency department discharges from 2011 to 2016, most patients had ambulatory follow-up within 30 days, with lower rates among Medicaid-eligible beneficiaries, Black beneficiaries, and those treated at rural emergency departments. Ambulatory follow-up was associated with a higher risk of subsequent hospitalization but a lower risk of 30-day mortality. Meaning The findings of this study suggest that access to ambulatory care may be a key driver of outcomes among Medicare beneficiaries discharged from the emergency department.

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Clinical Policy for Well-Appearing Infants and Children Younger Than 2 Years of Age Presenting to the Emergency Department With Fever

Cited by 21 publications

References 57 publications

The Outcome of Blood Cultures in Febrile Children Presenting at theEmergency Department

The Outcome of Blood Cultures in Febrile Children Presenting at theEmergency Department

Predicting serious bacterial infection in febrile young infants utilizing body temperature

Ambulatory Follow-up and Outcomes Among Medicare Beneficiaries After Emergency Department Discharge

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