Serious Infection in Children With Fever Often Missed

Emergency department physicians may fail to appropriately prescribe antibiotics as a result
By Jeff Muise
HealthDay Reporter

WEDNESDAY, April 21 (HealthDay News) -- Emergency department physicians tend to underestimate the likelihood of serious bacterial infection in young children presenting with fever, pointing to the need for improved diagnostic protocols, according to research published online April 20 in BMJ.

Jonathan C. Craig, Ph.D., of the University of Sydney in Australia, and colleagues studied data on 15,781 febrile illnesses in children (≤5 years old) who presented at the Children's Hospital at Westmead emergency department during 2004 to 2006. The researchers analyzed data on 40 clinical features collected by clinicians, their subsequent diagnoses, and the final confirmation or exclusion of serious bacterial infection (urinary tract infection, pneumonia, and bacteremia). The researchers evaluated a proposed computer-assisted clinical diagnostic model. They had follow-up data for 93 percent of the 15,781 febrile illnesses.

The investigators found that the combined prevalence of the three serious infections was 7.2 percent, with urinary tract infection and pneumonia accounting for 3.4 percent each and bacteremia accounting for 0.4 percent. More than 94 percent of those with serious infections had the appropriate tests, but antibiotics were prescribed acutely in only 66 percent of children with urinary tract infection, 69 percent with pneumonia, and 81 percent with bacteremia. The physicians' diagnoses of bacterial infection had low sensitivity (10 to 50 percent) but high specificity (90 to 100 percent), while the diagnostic model provided a broad range of values for sensitivity and specificity.

"Emergency department physicians tend to underestimate the likelihood of serious bacterial infection in young children with fever, leading to under-treatment with antibiotics. A clinical diagnostic model could improve decision making by increasing sensitivity for detecting serious bacterial infection, thereby improving early treatment," the authors write.

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