With regards to the literature I would refer everyone to Baraff's excellent
synopsis in the Ann Emerg Med 2000;36(6):602-614.
He mentions a case of Dr. Baker's that met low risk criteria and had
In ten years of practice, our group has been involved with many cases that
have suggested to me that anything can
happen. Off the top of my head:
20 day old with asymptomatic congenital hyronephrosis who progressed from
well, no known fever, to septic shock in three hours
- subsequently died. (Fisher JD. Arch Pediatr Adoles Med 1994;148:1102-3.)
2 month old with 102, smiling and playful during exam, LP revealed viral
meningitis (CSF WBC = 100), peripheral
WBC = 18K.
Medico-legal case upon which I was asked to opine:
7 week old with 102 at home, no fever in the ED without anti-pyresis, sent
home with no work-up - dead in 12
hours with meningococcal sepsis.
Jay Fisher MD
For more information, send mail to [log in to unmask] with the message: info PED-EM-L
The URL for the PED-EM-L Web Page is: