Febrile infants and children in the emergency department: Reducing fever to its simplest form

Starr, Mike

doi:10.1111/jpc.13112

Cited by 4 publications

(3 citation statements)

References 36 publications

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“…However, infants under 60 days of age have a higher risk of serious infection, which demands a cautious clinical approach, frequently with testing and empirical treatment. Multiple clinical criteria and local guidelines exist to stratify febrile infants into risk categories 2–9 ; however, the entry point of each of these is fever per se , and they all either mandate or advise consideration of investigations 10 …”

Section: What Is Already Known On This Topicmentioning

confidence: 99%

“…Multiple clinical criteria and local guidelines exist to stratify febrile infants into risk categories [2][3][4][5][6][7][8][9] ; however, the entry point of each of these is fever per se, and they all either mandate or advise consideration of investigations. 10 A young infant with fever on history but afebrile on arrival creates another layer of challenge. Clinicians are caught in a cleft stick: embark on an extensive workup based on reported, rather than objective fever, or miss the opportunity to recognise and treat a serious infection in a high-risk population by using clinical acumen and observation alone.…”

Section: What This Paper Addsmentioning

confidence: 99%

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Infrared thermometers and infants: The device is hot the baby maybe not

Tham

Davis

Hopper

2021

J Paediatrics Child Health

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Aim The risk of serious illness in febrile infants (<60 days old) is high, and so fever often warrants aggressive management. Infrared thermometers are unreliable in young infants despite their ubiquity. We aim to describe the: (i) frequency of infrared thermometer usage; (ii) progression to documented fever in the emergency department (ED) and (iii) rate of serious illness (meningitis, urinary tract infection and bacteremia). Methods In this single‐centre retrospective chart review at The Royal Children's Hospital, Melbourne, we audited medical records of infants (<60 days old) presenting to the ED with pre‐hospital fever on history over a 12‐month period. We described the type of thermometer used at home (tympanic or forehead, ‘infrared’ vs. axillary or rectal, ‘direct’) correlated to peak temperature in ED, investigations, treatment and diagnosis. The primary outcome was subsequent fever in ED. Results Of 159 infants, two of three had infrared temperature measurement at home. Fifty‐one (32.1%) developed fever in ED (direct 28/54, 52% vs. infrared 23/105, 22% RR 2.36 (95% CI 1.52–3.69)). Investigations (75%) and admission (60%) were common. Pre‐hospital fever alone was less likely to be associated with serious illness, with fever in ED a much stronger predictor. Conclusions In young infants, infrared thermometer use is common and less likely to predict subsequent fever. Twenty‐two percent of infants with fever via infrared measurement had fever in ED. History of fever without confirmation is less likely to signal serious illness. Education to public and health‐care providers is required to avoid usage of infrared devices in this population.

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Section: What Is Already Known On This Topicmentioning

confidence: 99%

Section: What This Paper Addsmentioning

confidence: 99%

Infrared thermometers and infants: The device is hot the baby maybe not

Tham

Davis

Hopper

2021

J Paediatrics Child Health

View full text Add to dashboard Cite

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“…Some procedures undertaken in the ED provide low diagnostic yield. These include blood cultures and inflammatory markers being used for risk stratification of well‐looking, immunised, febrile children as well as blood tests to exclude appendicitis in children presenting with less than 24 h of abdominal pain . In these circumstances, venepuncture could reasonably be replaced with a period of observation.…”

Section: First Do No Harmmentioning

confidence: 99%