Fever Without Focus Red Flags

Aka: Fever Without Focus Red Flags, Occult Bacteremia Signs in Young Children, Findings Suggestive of Serious Infection in Children Under Age 36 Months, Toxic Findings Suggestive of Occult Bacteremia

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II. Indications

  1. Fever Without Focus

III. Interpretation

  1. Positive findings define toxic or ill-appearance and increase risk of Occult Bacteremia
  2. All negative findings has Negative Likelihood Ratio of 0.1 (low serious infection risk)
  3. Assumes no serious underlying chronic disease
    1. No Immunosuppression
    2. No Sickle Cell Disease
    3. No Asplenia
    4. No Congenital Heart Disease
    5. No Ventriculoperitoneal Shunt
  4. Assumes no regular medical interventions
    1. No Hemodialysis
    2. No ongoing intravenous therapy
    3. No indwelling catheter

IV. Signs: Behavior change

  1. Decreased activity
  2. Does not interact with parents or environment
  3. Weak eye contact
  4. Irritability
  5. Lethargy or other Altered Level of Consciousness

V. Signs: Cardiopulmonary

  1. Cyanosis or other signs of poor perfusion
  2. Hyperventilation, hypoventilation or other signs of respiratory distress (e.g. grunting)
  3. Hypotension
  4. Tachycardia

VI. Signs: Miscellaneous

  1. Seizures
  2. Hypotonic
  3. Petechial rash
  4. Meningeal Irritation
  5. Bulging Fontanelle

VII. References

  1. Herman (2015) Crit Dec Emerg Med 29(12):14-19
  2. Irwin (2015) Pediatrics 135(4): 635-42 [PubMed]
  3. Van den Bruel (2010) Lancet 375(9717): 834-45 [PubMed]

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