Pediatric Fever Workup

[migraine12]

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Can you guys point me to a good website for current alogrithm for pediatric fever workup in the emergency department or let me know what your institutions current guidelines are?

 

[GeneralVeers]

Less than 8 weeks, temp > 38.0:

- CBC
- Blood culture
- Lumbar puncture
- CXR

Can discharge if negative with a shot of Rocephin.

8 weeks to 12 months:
If no obvious source (i.e. throat, ear infection)
then:
Urinalysis, urine culture
Discharge if negative and kid non-toxic, tolerating PO

> 12 months:
Reassure mom that kid will live (unless kid looks toxic)

 

[ERMudPhud]

8 weeks to 12 months:
If no obvious source (i.e. throat, ear infection)
then:
Urinalysis, urine culture
Discharge if negative and kid non-toxic, tolerating PO

This is of course from the time when kids are all vaccinated against haemophilus and pneumococcus. No too long ago we were checking cbc and ordering blood cultures on all those kids

 

[Quimby2]

I tried cutting and pasting the flow chart here, but no luck. (Keep in mind the article from Annals of Emerg Med is from 2000 and may not take into account some of the more recent data that includes studies on populations older than 2 mo who have began their PNA vaccine series.)

Baraff L. Management of fever without source in infants and
children. Ann Emerg Med 2000;36(6):602–14

A more recent review:
Ishimine P - Pediatr Clin North Am - 01-APR-2006; 53(2): 167-94

 

[Dr.Evil1]

Less than 8 weeks, temp > 38.0:

- CBC
- Blood culture
- Lumbar puncture
- CXR

Can discharge if negative with a shot of Rocephin.

8 weeks to 12 months:
If no obvious source (i.e. throat, ear infection)
then:
Urinalysis, urine culture
Discharge if negative and kid non-toxic, tolerating PO

> 12 months:
Reassure mom that kid will live (unless kid looks toxic)

Worked last night in our peds EM department and I can say we did some different stuff then this last night. There are some differences between 6 and 8 weeks in that you don't HAVE to do the LP if the kid looks good and is over 6 weeks. You also don't HAVE to give the shot of Rocephin if everything was negative...but I would. You are also overlooking doing a UA in the 0-8 wk infants. All infants less than 28 days with fever should be admitted regardless of what the workup shows.

Generally, though, this stuff changes so often. A good flow chart would be nice. There is probably something out there more recent than 2000 though.

 

[edinOH]

Google led me to this.

http://health.ucsd.edu/ClinicalResources/pedfever.PDF