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UCSF study: Pediatrician's judgment often better than clinical guidelines for treating infant fever

Pediatricians frequently use individual judgment in treating infants with fever, and according to a new study, this judgment is often as good as or better than following the current clinical guidelines on how to manage these cases.

Robert Pantell, MD, a pediatrician at UCSF Children's Hospital, is the lead investigator of "Management and Outcomes of Fever in Early Infancy," a study appearing in the March 10 issue of the Journal of the American Medical Association.

The researchers point out that infants who are running high fever often lack overt symptoms, thus making it difficult for the physician to know if the child has a serious bacterial illness such as bacteremia (bacteria in the blood) or bacterial meningitis. For children younger than one month, the guidelines state that the child should be hospitalized, and a whole battery of tests, including a spinal tap, be performed.

"These guidelines were developed following small studies at inner-city emergency departments," said Pantell, who also is a UCSF professor of pediatrics. "We wanted to see if these guidelines made sense for all children." The study team set out to discover what illnesses these children really have and what the physicians are doing to diagnose and treat them.

The researchers recruited 573 practitioners from the Pediatric Research in Office Settings (PROS) network of the American Academy of Pediatrics in 44 states, Washington, DC, and, and Puerto Rico. These physicians submitted data from 3,066 infants aged 3 months or younger with temperatures of at least 38 degrees Celsius (100.4 Fahrenheit).

The PROS clinicians hospitalized 36 percent of the infants, performed laboratory testing in 75 percent, and initially treated 57 percent with antibiotics, the researchers report. The majority (64 percent) were treated exclusively outside of the hospital. Bacteria in the blood was detected in 1.8 percent of infants (2.4 percent of those tested) and bacterial meningi
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Contact: Carol Hyman
chyman@pubaff.ucsf.edu
415-476-2557
University of California - San Francisco
9-Mar-2004


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