Infectious Disease Book

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Fever Without Focus Red Flags

Aka: Fever Without Focus Red Flags, Occult Bacteremia Signs in Young Children, Findings Suggestive of Serious Infection in Children Under Age 36 Months, Toxic Findings Suggestive of Occult Bacteremia
  1. See Also
    1. See Yale Observation Scale
    2. Fever Without Focus
    3. Fever Without Focus Management Birth to 3 Months
    4. Fever Without Focus Management 3 to 36 months
    5. Rochester Criteria for Febrile Infant 0 to 60 days
    6. Philadelphia Criteria for Febrile Infant 29-60 days
    7. Milwaukee Criteria for Febrile Infant 28-56 days
    8. Boston Criteria for Febrile Infant 28-89 days
    9. Neonatal Sepsis
  2. Indications
    1. Fever Without Focus
  3. 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
  4. 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
  5. 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
  6. Signs: Miscellaneous
    1. Seizures
    2. Hypotonic
    3. Petechial rash
    4. Meningeal Irritation
    5. Bulging Fontanelle
  7. References
    1. Herman (2015) Crit Dec Emerg Med 29(12):14-19
    2. Irwin (2015) Pediatrics 135(4): 635-42 [PubMed]
    3. Van den Bruel (2010) Lancet 375(9717): 834-45 [PubMed]

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