Management of the febrile patient

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Abstract
Fever is one of the most common complaints presented to the child's pediatrician or health provider. Some 20% of children seen in the office or clinic are there because of fever. The first decision the physician faces is over the phone: who should be seen immediately and who can be managed over the phone. The purpose of the consultation and the visit is to separate those with inconsequential febrile illness from those who have serious illnesses, bacterial illnesses in particular, since these could be life-threatening and are amenable to antimicrobial therapy. Many studies performed over the past 10 years are essentially in agreement that high fever in children younger than 2 years includes a subset of about 6 to 10% with bacteremia caused principally by S. pneumoniae and H. influenzae. The higher the fever (particularly over 40%) the higher the risk of bacteremia. Examination of the young child elicits two sets of findings. These are traditional physical clues to a specific diagnosis, such as tachypnea, crepitant rales, stiff neck, swollen joints and others. Additionally there are general observational clues dealing with how sick the child really is. The physician then needs to decide which of several possible laboratory tests need to be done in order to further refine a subset of children at high risk. The white count (less than 5000 or greater than 15,000), the band count (greater than 1500) and the sedimentation rate (greater than 30 mm/hour) have proved useful in various studies, as has examination of the urine.(ABSTRACT TRUNCATED AT 250 WORDS)

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