title: Evaluation of the precision of emergency department diagnoses in young children with fever.
abstract: OBJECTIVE. To characterize causes of fever in children presenting to a pediatric emergency department (ED). METHODS. One-year retrospective review of ED records. Inclusion criteria were 2 to 36 months of age with a documented temperature ≥ 39°C. Exclusion criteria were elopement, repeat visit, and underlying diagnosis with a predisposition to infection. Medical records were reviewed using a predefined, study-specific, data abstraction tool. Based on diagnosis and pathogen detection, visits were assigned to 3 groups, laboratory confirmed pathogen and focal or nonfocal diagnosis without confirmed pathogen. RESULTS. A total of 1091 visits met inclusion criteria. Fourteen percent had a pathogen detected, 56% had a focal diagnosis without a confirmed pathogen, and 30% had a nonfocal diagnosis without confirmed pathogen. CONCLUSIONS. In a cohort of febrile children 2 to 36 months of age, only 14% had a confirmed pathogen. New rapid viral diagnostic techniques may provide an opportunity to improve diagnostic certainty in young children presenting with fever.
authors.affiliation: Children's Hospital of Central California, Madera, CA, USA.
authors.forename: Joshua M
authors.initials: JM
authors.lastname: Colvin
authors.forename: David M
authors.initials: DM
authors.lastname: Jaffe
authors.forename: Jared T
authors.initials: JT
authors.lastname: Muenzer
mesh_terms: D016009:Chi-Square Distribution; D002675:Child, Preschool; D003937:Diagnosis, Differential; D004636:Emergency Service, Hospital; D005260:Female; D005335:Fever of Unknown Origin / Q000175:diagnosis* / Q000382:microbiology; D006801:Humans; D007223:Infant; D008297:Male; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012720:Severity of Illness Index