Few apparently healthy febrile infants see their condition deteriorate after discharge from the ED

Why is this important?

The consequences of a missed infection are significant, but a thorough workup can be counterproductive.
Most pathogens can be isolated within 24 hours.

Principle results

0.42% of patients (n=72) had true bacteraemia.
- 35 patients had received 2 of 3 doses of pneumococcal vaccine.
- Two patients had received one dose.
The most common bacteria were species Streptococcus pneumoniae, Kingella kingaeet Salmonella.
Followed :
- 85.7% of patients (n = 60) were called back to the pediatric emergency department (ED) or had an appointment scheduled.
- 14.3% of patients (n=10) returned spontaneously.
- Two patients were contacted by telephone.
84.7% of patients were hospitalized.
- Median length of stay: 5.6 days (interquartile range [IIQ] : 2,8–6,4).
- One patient was subsequently admitted to intensive care.
Median time between visits: 28.7 hours (IQR: 19.1–41.1).
One child presented with endocarditis resulting in hemiparesis, facial paralysis and seizure disorders.
Another child presented with meningitis resulting in hearing loss.
No deaths were reported.

Methodology

A retrospective, single-center cohort study included healthy-appearing, immunocompetent children in Israel, 3 to 36 months of age (n = 17,114).
All children were evaluated for fever, cultured, and discharged home.
Endpoint: death; admission to intensive care.
Funding: no funding has been communicated.

Limits