Fever of Unknown Source - Part 2

In this episode we complete our discussion on “Fever Without a Source” in the 2-3 month old population and also cover the 3-month plus age group.  Again Dr. Andrea Cruz a subspecialist in emergency medicine and infectious disease at The Texas Children’s Hospital gives us some further insight into when and how to work these kids up.

Full disclosure: The author on two of the articles below is LCDR Sherry Rudinsky who is an old navy friend of mine.  We were interns together and then attended the same Naval Flight School class.  Dr. Carstairs is also an aquantaince; she was a resident when I was a Navy Surgical Intern.  I was stationed at the Naval Medical Center San Diego when they were collecting their data, but I had no part in this study.  They are simply dang good reads so check them out.

iTunes Link

Fever Algorithm

Fever Part 2 - MP3 Version

References:

Reardon JM, Carstairs KL, Rudinsky SL, Simon LV, Riffenburgh RH, Tanen DA. Urinalysis is not reliable to detect a urinary tract infection in febrile infants presenting to the ED. Am J Emerg Med. 2009 Oct;27(8):930-2. PubMed PMID: 19857409.

Rudinsky SL, Carstairs KL, Reardon JM, Simon LV, Riffenburgh RH, Tanen DA. Serious bacterial infections in febrile infants in the post-pneumococcal conjugate vaccine era. Acad Emerg Med. 2009 Jul;16(7):585-90. Epub 2009 Jun 15. PubMed PMID: 19538500.\

Carstairs KL, Tanen DA, Johnson AS, Kailes SB, Riffenburgh RH. Pneumococcal bacteremia in febrile infants presenting to the emergency department before and after the introduction of the heptavalent pneumococcal vaccine. Ann Emerg Med. 2007 Jun;49(6):772-7. Epub 2007 Mar 6. PubMed PMID: 17337092.

Podcast 3 - Fever of Unknown Source Part Two

Comments

[Eva]

Thanks for letting me know about other good stuff!

[Thomas Upshaw]

excellent podcast on Fever! However, I found the approach to the 3-6 month old with a fever somewhat confusing. Although there are "different schools of thought" in approaching the workup of this group, this is not to say that all schools are equally evidence based. If the incidence of SBI is less than 1/10000 in the immunized in this age group then it seems irrational to get a CBC +/- BCs in this group. It seems like in the community those that are comfortable with what a well appearing 4 months looks like are checking urines alone where as those that are less comfortable with this age group are falling back on the traditional w/u of CBC,BC, UA +/- CXR. Your thoughts?

[Mike Miescier]

Can you please explain the data behind the advice to check a CBC and blood culture for children 3-6 months of age? I see this same advice elsewhere, but never see any data that support that approach. I feel that the Carstairs article supports the concept that one dose of Prevnar offers excellent protection.

Thanks,
Mike Peds EM Fellow

[ken]

I like the fever information. What about hypothermia. I remember reading that in the neonate a low temp should also prompt a sepsis workup. However, I can't seem to find anything about what temp is too low. After talking to a bunch of peds and em docs, people seem to use a lot of different cutoffs.