Fever without source in infants and young children: dilemma in diagnosis and management

Figures & data

Table 1 Rochester criteria for the assessment of bacterial infection risk in febrile young infants⁷

Clinical criteria	Laboratory criteria
Low risk criteria for serious bacterial infection
• No prior illness	• White blood cell count between 5000 and 15,000/mm^3
• Full-term birth without complications during hospital stay after delivery	• Absolute neutrophil count < 1500/mm^3
• Well-appearing infant with no evidence of bacterial infection during physical examination	• Urine white blood cell count < 10/hpf
• No chronic illness	• Fecal leukocytes < 5/hpf in children with diarrhea

Abbreviation: hpf, high power field.

Table 2 Characteristics of the sample and children’s clinical evaluation according to stratification into age groups

Variables	General (n = 385) (100%)	<30 days (n = 104) (27%)	1–3 months (n = 113) (29.4%)	3–36 months (n = 168) (43.6%)
Male/female	195/190	51/53	65/48	79/89
Toxemia	15 (3.9)	6 (5.8)	4 (3.5)	5 (2.97)
Without toxemia	370 (96.1)	98 (94.2)	109 (96.5)	163 (97.3)
SBI	26 (6.8)	9 (8.7)	9 (7.96)	8 (4.8)
SBI in patients without toxemia	12 (3.2)	4 (4.1)	5 (4.6)	3 (1.8)
Presenting symptoms
Temperature > 39°C	142 (36.9)	13 (13.3)	67 (59.3)	62 (36.9)
Decreased feeding	212 (55.1)	60 (57.69)	60 (53.1)	92 (54.7)
Urinary symptoms	95 (24.9)	16 (15.3)	38 (33.6)	41 (24.4)
Final diagnosis
UTI	150 (39)	42 (40.4)	41 (36.3)	67 (39.9)
Self-limited disease or probable viral etiology	143 (37.1)	41 (39.4)	44 (38.9)	58 (34.5)
Meningitis	13 (3.4)	5 (4.8)	5 (4.4)	3 (1.8)
Pneumonia	19 (4.9)	6 (5.8)	6 (5.3)	7 (4.2)
Bronchiolitis	15 (3.9)	5 (4.8)	4 (3.5)	6 (3.6)
OB	9 (2.3)	4 (3.8)	2 (1.8)	3 (0.6)
URTI	30 (7.8)	1 (0.96)	11 (9.7)	18 (10.7)
Viral exanthema	6 (1.7)	0 (0)	0 (0)	6 (3.6)
Total	385 (100)	104 (100)	113 (100)	168 (100)
Patients without toxemia receiving
Empirical antibiotic		0	55 (53.4)	41 (25.8)
Specific antibiotic		96	48 (46.6)	77 (48.4)
No antibiotic		0	0	41 (25.8)
Total		96	103	159

Abbreviations: n, number; SBI, serious bacterial infection; UTI, urinary tract infection; OB, occult bacteremia; URTI, upper respiratory tract infection.

Table 3 Final diagnoses established for patients with toxemia

Final diagnoses	SBI			Total (n = 26) (%)
	Newborn (n = 9) (%)	Young infants (n = 9) (%)	Older infants (n = 8) (%)
% of total number per age group	8.7	7.96	4.8	6.8
UTI	3 (33.3)	2 (22.2)	3 (37.5)	8 (28.6)
Meningitis	2 (22.2)	2 (22.2)	1 (12.5)	5 (19.2)
Pneumonia	1 (11.1)	2 (22.2)	2 (25)	5 (19.2)
Bronchiolitis	1 (11.1)	1 (11.1)	0 (0)	2 (7.7)
OB	2 (22.2)	2 (22.2)	1 (12.5)	5 (19.2)
Viral exanthema	0 (0)	0 (0)	1 (12.5)	1 (3.8)
Total	9 (100)	9 (100)	8 (100)	26 (100)

Abbreviations: SBI, serious bacterial infection; UTI, urinary tract infection; OB, occult bacteremia.

American College of Emergency Physicians Clinical Policies Committee, American College of Emergency Physicians Clinical Policies Subcommittee on Pediatric FeverClinical policy for children younger than three years presenting to the emergency department with feverAnn Emerg Med200342453054514520324

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