FEVER IN CHILDREN

KERI A. COHN, MD, MPH, DTM&H, FRAN BALAMUTH, MD, PhD, MSCE, RONALD F. MARCHESE, MD, PhD, ELIZABETH R. ALPERN, MD, MSCE, AND FRED M. HENRETIG, MD

BACKGROUND (EPIDEMIOLOGY, EVIDENCE)

Fever is among the most common causes for parents to seek care for their children in an emergency department. The importance of fever lies in its role as a physiologic expression of disease. The care of a febrile child focuses on discovering the cause of the fever and treating the underlying illness. Height and duration of fever, associated signs and symptoms, exposures, and host factors are all essential clues to the proper evaluation of the febrile patient. The changing epidemiology of infectious agents, especially in an era of new vaccines and antibiotic resistance, complicates the approach to medical evaluation and treatment. Combining expert consensus and evidence-based medicine in an algorithmic approach may prevent unnecessary medical testing and antibiotic treatment, while identifying those patients who warrant further evaluation. Time spent on educating parents about supportive care during an acute febrile viral illness may minimize return visits and assuage concern, while providing clear indications for when to seek care for further evaluation. Additionally, patients at higher risk for severe infections or conditions can be identified promptly, and their management aggressively pursued in order to optimize patient care and outcome.

PATHWAY GOALS AND MEASUREMENTS

Goals

Identify patients with fever who are at increased risk for infection requiring antimicrobials or supportive medical intervention.

Early identification, evaluation, and management of patients with high-risk factors or severe signs and symptoms of disease.

Adequate review of discharge instructions with patients and families including indications for return to medical care and review of supportive care including hydration and antipyretics.

Measurements

Appropriate antibiotic choice and use

Decrease in ancillary testing for patients with viral acute respiratory tract infection

Time to antibiotics, appropriateness of antibiotic choice in high-risk patients

Increased documented use of appropriate discharge instructions to families including indications for return to medical care, and review of supportive care including hydration and antipyretics