II. Indications

III. Interpretation

  1. Positive findings define toxic or ill-appearance and increase risk of Occult Bacteremia
  2. All negative findings has Negative Likelihood Ratio of 0.1 (low serious infection risk)
  3. Assumes no serious underlying chronic disease
    1. No immunosuppression
    2. No Sickle Cell Disease
    3. No Asplenia
    4. No Congenital Heart Disease
    5. No Ventriculoperitoneal Shunt
  4. Assumes no regular medical interventions
    1. No Hemodialysis
    2. No ongoing intravenous therapy
    3. No indwelling catheter

IV. Signs: Behavior change

  1. Decreased activity
  2. Does not interact with parents or environment
  3. Weak eye contact
  4. Irritability
  5. Lethargy or other Altered Level of Consciousness

V. Signs: Cardiopulmonary

  1. Cyanosis or other signs of poor perfusion
  2. Hyperventilation, hypoventilation or other signs of respiratory distress (e.g. grunting)
  3. Hypotension
  4. Tachycardia

VI. Signs: Miscellaneous

  1. Seizures
  2. Hypotonic
  3. Petechial rash
  4. Meningeal Irritation
  5. Bulging Fontanelle

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