Full Title: Diagnosis and Management of Febrile Infants (0–3 Months)March 2012
The febrile infant is a common clinical problem that accounts for a large number of ambulatory care visits. Young febrile infants (age 0–3 months) often present with nonspecific symptoms and it is difficult to distinguish between infants with a viral syndrome and those with early serious bacterial illness. This evidence report is designed to review the literature about the management of the febrile infant and to identify needs for future research.
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Review Methods: Two independent reviewers screened the literature and extracted data on population characteristics, index/diagnostic test characteristics. Diagnostic test accuracy studies were assessed using Quality Assessment of Diagnostic Accuracy Studies.
Results: Eighty-four original studies were included. The combined clinical and laboratory criteria (Rochester, Philadelphia, Boston, and Milwaukee) demonstrated similar overall accuracy (sensitivity: 84.4 percent to 100.0 percent; specificity: 26.6 percent to 69.0 percent; negative predictive value: 93.7 percent to 100.0 percent; and positive predictive value: 3.3 percent to 48.6 percent) for identifying infants with SBI. The criteria based on history of recent immunization or rapid influenza test demonstrated higher sensitivity but lower specificity compared with criteria based on age, gender, and the degree of fever. The overall accuracy of C-reactive protein was greater than that for absolute neutrophil count and absolute band counts , white blood cell, and procalcitonin.
For correctly identifying infants with and without SBI (or bacteremia), the Boston, Philadelphia, and Milwaukee criteria/protocol showed better overall accuracy when applied to older infants versus neonates. The Rochester criteria were more accurate in neonates than in older infants.
Download ReportDiagnosis and Management of Febrile Infants (0–3 Months)
Current as of March 2012
Diagnosis and Management of Febrile Infants, Structured Abstract. March 2012. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/clinic/tp/febrinftp.htm
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