Infectious Disease Book

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Boston Criteria for Febrile Infant 28-89 days

Aka: Boston Criteria for Febrile Infant 28-89 days, Boston Criteria for Febrile Infant, Boston Criteria for Evaluation of the Infant with Fever, Febrile Infant Evaluation with Boston Criteria
  1. See Also
    1. Fever Without Focus
    2. Fever Without Focus Management Birth to 3 Months
    3. Fever Without Focus Management 3 to 36 months
    4. Rochester Criteria for Febrile Infant 0 to 60 days
    5. Philadelphia Criteria for Febrile Infant 29-60 days
    6. Milwaukee Criteria for Febrile Infant 28-56 days
    7. Yale Scale for Febrile Child 3 to 36 months
    8. Pediatric Sepsis
    9. Neonatal Sepsis
    10. Fever Without Focus Red Flags
  2. Indications
    1. Assessment of febrile child (>38 C) aged 28-89 days
    2. Reassures against serious infection (Occult Bacteremia)
  3. Criteria: Reassuring if all criteria are present
    1. Well appearing infant
    2. No skeletal, soft tissue, skin or ear infections
    3. No confounding factors
      1. No Immunizations in preceding 48 hours
      2. No antibiotics in preceding 48 hours
      3. Not dehydrated
    4. Normal labs
      1. CSF <10 cells/mm3
      2. Urinalysis <10 WBC/hpf
      3. WBC <20,000/mm3
      4. Chest XRay without infiltrate
  4. Interpretation
    1. Higher risk
      1. Admit and start empiric antibiotics
    2. Lower risk (all reassuring criteria met)
      1. Occult Bacteremia occurred in 5% of patients studied and these criteria did not rule-out Occult Bacteremia
      2. Supports discharge with antibiotics and with close interval follow-up
        1. Infants with all reassuring criteria present were safely discharged to home in the study
        2. All discharged infants were given empiric Ceftriaxone and followed up in 24 hours
  5. Efficacy
    1. Test Specificity: 94.6%
  6. References
    1. Bachur (2001) Pediatrics 108(2): 311-6 [PubMed]
    2. Baker (2008) Clin Ped Emerg Med 9:213-20 [PubMed]
    3. Baskin (1992) J Pediatr 120(1): 22-7 [PubMed]

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