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The young febrile child. Results of a multicenter survey

Abstract:

Objectives: To establish the value of clinical and laboratory parameters gathered from a national survey on the management of the young febrile child (0-36 months) in emergency departments and to determine the etiology of potentially serious bacterial infections in Spain in this group of patients. Patients and methods: Prospective survey of febrile children aged less than 36 months who presented to the emergency departments of the participant hospitals and who fulfilled the inclusion criteria. Results: A total of 937 cases were collected. Of these, 43 were excluded because of absence of blood culture and 151 because the patients had not undergone obligatory monitoring until they became afebrile or had no final diagnosis. Consequently, the sample size consisted of 743 patients. Clinical assessment was very important to detect patients with potentially serious bacterial disease. Among the laboratory parameters, a white blood cell count above 15,000/μl or below 5,000/μl and elevated C-reactive protein levels were the most useful. Urinary tract infection was the most freuent invasive disease. Neisseria meningitidis was the most frequent microorganism isolated in the blood culture. The incidence of occult bacteremia was 3% with predominance of Streptococcus pneumoniae (74%). Conclusions: The experience of the pediatrician supported by clinical and laboratory parameters are the most effective means of detecting febrile children (0-36 months) with potentially serious bacterial disease.