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Febrile_Child - Febrile Child Overview Introduction Occult...

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Febrile Child
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Overview Introduction Occult bacteremia Antibiotic prevention of SBI Febrile seizure Fever and petechiae Fever in children with underlying illness Rare syndromes
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Introduction Historical perspective Toxic looking child Fever, menigeal signs, lethargic, limb, mottled Admit, septic work-up, parental antibiotics Focal bacterial infection Any child with focal bacterial infection (excluding SBI) such as OM, pharyngitis, sinusitis, etc. Oral antibiotics, outpatient care Well looking child Risk for occult bacteremia and serious bacterial infection Previous decision analysis: pre-H. flu immunization Current decision analysis
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Occult Bacteremia Incidence of occult bacteremia Rosen: 3% to 5% EMR: 2.8% Fleisher et al Pediatrics 1994 Alpern et al AAP Sept 2000: 1.9% Baraff et at Ann Emerg Med 1993: 4.3% Organism implicated in OB Rosen: 85% strep pneumo; 15% H. flu, N. men., Salmonella and others EMR: strep pneumo and H. flu 99% Alpern et al: S. pneumo 82.9%, Salmonella 5.4%, Group A strep 4.5%, Enterococcus 1.8%, M. cat 1.8%, and no H. flu Baraff et al Ann Emerg Med 1993: S. pneumo 85%, H. flu 10%, N. men 5%
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Occult Bacteremia Degree of temperature elevation Rosen: 39.5 to 39.9 degrees C 3%; 40 to 40.9 4%; above 41 10% (Harper and Fleisher Pediatrics Ann 1993) EMR: 39.0 to 39.9 1.9%; 40.0 to 40.9 3%; 41+ 9% Alpern et al Pediatrics Sept 2000: 40+ 2.9 times more likely to have OB Age of the child Rosen: children 24 to 36 months are less likely than those under 24 months EMR: most OB between 6 to 18 months Alpern et at highest incidence 12-17 months
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Occult Bacteremia WBC Rosen: cases of H. flu one third of OB have WBC under 15,000; meningococcemia who appear well 50% will have WBC under 15,000: cases of pneumococcal bacteremia one quarter will have WBC under 15,000 EMR: using 15,000 as cut-off will miss 35% of bcateremic children
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