Regarding workup of fever with URI:
I'd like to second Jeff Avner's comments. I think he very clearly stated
what has become a muddy issue.
The indicence of occult bacteremia is somewhere between 3-4% of well
appearing children with temps in excess of 100.5 F (38.0C). Of these 97%
will be caused by S. pneumonia of which 3-5% will go on to cause a serious
bacterial infection. If you do the math then somewhere in the range of
0.1%-0.3% of children with fever's will develop serious bacterial
A CBC (i.e. WBC>15,000) will not in any reliable way destinguish the 99.7%
of children who will be fine with no treatment from the 0.3% who will
develop an SBI. In addition a blood culture will also not help since the
child with a bacteremia in the ED will either clear it spontaneously or
return for further treatment before the cultures register as positive.
Jeff is absolutely correct in his opinion that, a good H&P with close
followup will produce the same outcome as any combination of labs and
One other point, we do get urine cultures in children with fever's without
sources. (Unless of course someone hallucinates an Otitis Media and treats
them with antibiotics).
Our Lady of Lourdes Medical Center
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