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For the person asking about strep,,see this months issue of PIR..
At our institution we also use two swabs and collect the specimens
concomitantly, if the rapid assay is negative, the second is plated..Follow
up is provided via our QA nurse.. The only problem is whether or not we
should treat those kids with positive cultures via po or have them present
for an injection. I generally give the parents the option.
Actually one could make the argument that just treating suspicious throats
would be more cost efficient..especially since ARF is so rare..
 
Now regarding the issue of febrile seizures... I concur with those who
posted except for the comment re high WBC...since the positive predictive
value of a peripheral WBC is no better than chance...it would be a bad idea
to use it as a guide for whether to tap a febrile child who had a seizure..
I am also not so sure that  the height of the temperature provides any
better specificity in detecting those likely to have meningitis or
encephalitis.
 
In general, I rely on my impression as to whether the child appears ill..
 Yale Observation Scale or Rochester Scale provides the same information as
my gestalt)
I will tap the first time fitter, if they are <18 month and still not
functioning normally ( post ictal or otherwise lethargic,listless etc) . If
the child is already up and playing, by the time I examine them, then the LP
seems unnecessary to me..
 
I believe this issue was reviewed in PIR in the past few months as well..
 
Lets hear more ..
 
Martin Herman, M.D>
 
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The URL for the PED-EM-L Web Page is:
  http://www.brown.edu/Administration/Emergency_Medicine/ped-em-l.html