Fever without source: evaluation of a guideline.
OBJECTIVE
To evaluate the applicability of a standardized guideline for children up to 36 months of age with fever without source (FWS).


METHODS
Prospective cohort study involving children with FWS treated at the emergency department of Hospital Universitário, Universidade de São Paulo, São Paulo, Brazil, from June 2006 to May 2007. The guideline classifies the risk of serious bacterial infection (SBI) according to the presence or absence of toxemia, age, and temperature. Laboratory screening was based on risk assessment: complete blood count, blood culture, urinalysis, urine culture, and, if necessary, chest radiography, cerebrospinal fluid, and coproculture.


RESULTS
We studied 251 children and, of these, 215 were followed up until the final diagnosis. Toxemia was found in 20 children, and 195 were well-appearing (30 up to 3 months old and 165 from 3 to 36 months old). Among those children from 3 to 36 months without toxemia, 95 had axillary temperature > 39 degrees C. In 107 (49.8%) children, there was spontaneous resolution of fever; in 88 (40.9%), benign self-limited disease was identified; and in 20 (9.3%), there was SBI. Among the cases of SBI, we identified 16 urinary tract infections, three cases of pneumonia and one occult bacteremia. Of the 215 children, 129 (60%) received no antibiotics, and 86 received antibiotics at some point (45 empirically). Empirical antibiotic treatment was maintained for an average of 72 hours.


CONCLUSIONS
The guideline was shown to be appropriate to follow up these children using simple laboratory tests that can be carried out at most health facilities. The most frequent SBI in this sample was urinary tract infection.
Machado
Beatriz Marcondes
BM
Departamento de Pediatria, Faculdade de Medicina, Universidade de São Paulo (USP), São Paulo, SP, Brazil. beatriz@hu.usp.br
Cardoso
Débora Morais
DM
de Paulis
Milena
M
Escobar
Ana Maria de Ulhôa
AM
Gilio
Alfredo Elias
AE
D001424:Bacterial Infections / Q000175:diagnosis* / Q000453:epidemiology; D001938:Brazil / Q000453:epidemiology; D002675:Child, Preschool; D005260:Female; D005335:Fever of Unknown Origin / Q000209:etiology*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D017410:Practice Guidelines as Topic / Q000592:standards*; D011446:Prospective Studies; D014115:Toxemia / Q000175:diagnosis* / Q000453:epidemiology; D014552:Urinary Tract Infections / Q000175:diagnosis / Q000453:epidemiology