Marty beat me to this posting. I was going to ask the group about this.
Last week I received a call from a local pediatric group (a decent one).
They wanted me to QI a case. We had seen an 8 month old with a fever of 105
and some diarrhea and dehydration and provided IVFs. But we didn't do any
testing and therefore "missed" the fact that the child had strep.
I really have no idea how to respond to this other than to say that I
believe strep was not the cause and that nothing was "missed". But I think
that this only results in a he said - she said discussion where the
community physicians and ED physicians each think that the other is wrong.
Does anyone believe that strep can cause high fevers in infants less than a
year of age? Who should be swabbed?
(I am not questioning the treatment of a positive strep swab. I think that
once you do the test and get a positive, you are stuck).
On Mon, Feb 20, 2012 at 3:18 PM, Marty Herman <[log in to unmask]> wrote:
> SO for years I have been puzzled why folks swab for strep in kids less
> than 2. When I read the Red Book it says testing for Strep in kids 2-3 is
> marginally indicated. They say typically 3 and up. According to what I have
> been told Rheumatic Fever doesn't occur in kids < 2, and is rare anyway and
> so if the reason we swab for strep is to prevent RF by early intervention,
> then why waste the money in kids < 2?If it's to limit the symptoms, avoid
> spreading contagion especially to daycare classmates, and or to allow
> parents to return to work sooner, why don't we screen for other causes of
> treatable bacterial infections like Eikenella, or arcanybacterium or
> mycoplasma? Studies done looking at the treatment with Penicillin and
> cephalosporins excluded kids under 3 ( Pediatric Annals May 1998 . the
> entire issue is dedicated to Group A Strep Infections. ). SO how do we know
> that treating kids <2 is actually worthwhile? SO do you see patients who
> have been diagnosed with "Strep" pharyngitis that are < 2? Do you swab and
> treat kids < 2 if positive?
> Martin Herman, M.D.
> Pediatric Emergency Medicine
> Sacred Heart Children's Hospital
> FSU @ Sacred Heart, Division of Pediatrics
> 5153 N. 9th Ave, 6th Floor Nemours Bldg
> Pensacola, FL 32504
> Ph: 850 416 7658(office)
> Ph: 901 219 9202 ( cell)
> Fx: 850 416 7677
> Email: [log in to unmask]
> CONFIDENTIALITY NOTICE:
> This email message and any accompanying data or files is confidential and
> may contain privileged information intended only for the named
> recipient(s). If you are not the intended recipient(s), you are hereby
> notified that the dissemination, distribution, and or copying of this
> message is strictly prohibited. If you receive this message in error, or
> are not the named recipient(s), please notify the sender at the email
> address above, delete this email from your computer, and destroy any copies
> in any form immediately. Receipt by anyone other than the named
> recipient(s) is not a waiver of any attorney-client, work product, or other
> applicable privilege.
> 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:
Rick Place, MD
Department of Emergency Medicine
Inova Fairfax Hospital for Children
3300 Gallows Road
Falls Church, VA 22042
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: