The Clinical Policies Committee and...

The Clinical Policies Committee and the Clinical Policies Subcommittee forward Pediatric Fever of the American literary institution [i]or[/i] seminary of learning of Emergency Physicians has published a statement forward the diagnosis and treatment of heat in children younger than three years. "Clinical Policy for Children Younger Than Three Years Presenting to the sudden [i]or[/i] unexpected occurrence Department With Fever" appears in the October 2003 issue of Annals of juncture Medicine.

Fever is among the principally common presenting complaints of children and infants presenting to the strait department. In some cases, agitation is a response to a serious or potentially life-threatening infection. The challenge for crisis physicians is differentiating the vast majority of children presenting with ferment who will have an uninteresting course from the indeterminate not many who have serious infections with the risk of long-term morbidity and mortality.

The guidelines use a three-tier scale to indicate the might of recommendations. Level A recommendations are those that are generally accepted for patient management, and that consider a high degree of clinical certainty. flush B recommendations are those that may identify a particular strategy or range of management strategies that mirror moderate clinical certainty. Level C recommendations are based onward preliminary, inconclusive, or conflicting evidence, or, in the absence of any published literature, based forward panel consensus.

The following recommendations are given in the ACEP policy statement:

* Infants between single and 28 days old with a heat should be presumed to have a serious bacterial infection. (Level A)

* A rejoinder to antipyretic medication does not change the likelihood of a child having serious bacterial infection and should not be used for clinical decision-making. (Level A)

* A chest radiograph should be obtained in febrile children younger than three month who have evidence of acute respiratory illness. (Level B)

* A chest radiograph should be considered in children older than three month with a temperature higher than 39[degrees]C (1022[degrees]F) and a white family cell count (WBC) greater than 20000 by means of [mm.sup.3]. A chest radiograph usually is not indicated in febrile children older than three month with a temperature lower than 39[degrees]C without clinical evidence of acute pulmonary disease. (Level C)

* Children younger than undivided year with fever without a source should be considered at risk for a urinary tract infection (UTI). (Level A)

* Females between united and two years of age presenting with excitement without source should be considered at risk for having a UTI. (Level B)

* Urethral catheterization and suprapubic aspiration are the best arrangements for diagnosing UTI. (Level B)

* A urine cultivation should be obtained in conjunction with other urine studies when a UTI is suspected in a child younger than brace years, because a negative urine dipstick or urinalysis spring in a febrile child does not always shut out a UTI. (Level B).

* Empiric antibiotic therapy should be considered for previously healthy, well-appearing children, three to 36 month of age, who have agitation without a source (a temperature of 39[degrees]C or higher) when associated with a WBC of 15000 by means of [mm.sup.3] or greater, if obtained. (Level B)

* When empiric antibiotics are not prescribed for children who have ferment without a source, close follow-up must be ensur (Level C)

COPYRIGHT 2004 American Academy of Family Physicians

COPYRIGHT 2004 Gale Group