How is the risk of unrecognized bacterial infection minimized in the emergent management of pediatric patients with fever?

Updated: Jul 23, 2019
  • Author: Hina Z Ghory, MD; Chief Editor: Russell W Steele, MD  more...
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Answer

Answer

Discharging a child from the emergency department (ED) with an unrecognized serious bacterial infection is a potential medicolegal risk for the ED physician. The risk is minimized by performing and documenting an appropriate history, physical examination, and, when indicated, a workup, as well as ensuring effective follow-up care. [36]

Several factors indicate an increased risk of bacteremia and/or sepsis, including age less than 2 months, an immunocompromised state (eg, neutropenic or underlying malignancy), being unvaccinated or undervaccinated, hypothermia (core temperature < 36.8°C, or 98°F), and hyperthermia (core temperature >40.5°C, or 105°F). [37]

Some pediatric patients may be potentially at a higher risk for bacterial illness than their age-matched counterparts. Special consideration for these populations should include appropriate evaluation in the ED, documentation of consultation with specialists, and chart documentation related to special needs.


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