title: Emergency department evaluation of febrile children after the introduction of Prevnar.
abstract: The Emergency Department work-up of febrile children is largely driven by the risk of occult bacteremia. This study was designed to determine if emergency medicine doctors had changed their work-up of febrile children after introduction of the pneumococcal conjugate vaccine (PCV) in 2000. We surveyed 411 licensed emergency doctors in Tennessee in 2001. Participants were presented with a hypothetical eight-month-old, well-appearing child with a temperature of 102.2 degrees F with no source of infection. They were asked about practice setting, years in practice, laboratory evaluation and whether their work-up of febrile children had changed in the past year. Of those surveyed, 238 (58%) of 411 completed a survey. Of these, 39 were excluded, leaving a study group of 199. Thirty-two (16%) of 196 respondents to the practice-setting question worked in university-affiliated hospitals, and 164 (84%) worked in community hospitals. Twenty-seven (14%) of 196 respondents had been in practice for five years or less, and 169 (86%) respondents had been in practice for greater than five years. One-hundred-and-thirty-eight (69%) of 199 respondents chose to order a complete blood count and 92 (46%) respondents ordered blood cultures. Overall, 22 (11%) respondents stated that they had changed their work-up in the past year. This survey of emergency doctors demonstrates that changes in the work-up of the febrile child were beginning to occur in the year after the introduction of PCV. Because of the dramatic decrease in invasive pneumococcal disease since introduction of the vaccine, future surveys will be needed to determine if the evaluation of febrile children has changed since this survey was conducted.
authors.affiliation: Department of Emergency Medicine, US Naval Medical Center, Portsmouth, USA.
authors.forename: John P
authors.initials: JP
authors.lastname: Colmenares
authors.forename: Allen S
authors.initials: AS
authors.lastname: Craig
authors.forename: Patricia S
authors.initials: PS
authors.lastname: Chu
authors.forename: William
authors.initials: W
authors.lastname: Schaffner
mesh_terms: D016470:Bacteremia / Q000150:complications; D002648:Child; D003625:Data Collection; D004635:Emergency Medicine; D005334:Fever / Q000209:etiology*; D000069443:Heptavalent Pneumococcal Conjugate Vaccine; D006801:Humans; D022401:Meningococcal Vaccines / Q000008:administration & dosage*; D022242:Pneumococcal Vaccines / Q000008:administration & dosage*; D010818:Practice Patterns, Physicians'; D013714:Tennessee
chemical_list: D000069443:Heptavalent Pneumococcal Conjugate Vaccine; D022401:Meningococcal Vaccines; D022242:Pneumococcal Vaccines