0
We're unable to sign you in at this time. Please try again in a few minutes.
Retry
We were able to sign you in, but your subscription(s) could not be found. Please try again in a few minutes.
Retry
There may be a problem with your account. Please contact the AMA Service Center to resolve this issue.
Contact the AMA Service Center:
Telephone: 1 (800) 262-2350 or 1 (312) 670-7827  *   Email: subscriptions@jamanetwork.com
Error Message ......
Viewpoint |

The Future Possibilities of Diagnostic Testing for the Evaluation of Febrile Infants

Prashant Mahajan, MD, MPH, MBA1; Octavio Ramilo, MD2; Nathan Kuppermann, MD, MPH3
[+] Author Affiliations
1Department of Pediatrics and Emergency Medicine, Wayne State University School of Medicine, Children’s Hospital of Michigan, Detroit
2Department of Pediatrics, Nationwide Children’s Hospital and Ohio State University, Columbus
3Department of Emergency Medicine, University of California, Davis School of Medicine, Sacramento
JAMA Pediatr. 2013;167(10):888-898. doi:10.1001/jamapediatrics.2013.2491.
Text Size: A A A
Published online

Extract

Fever is one of the most common reasons for childhood visits to emergency departments and primary care practitioners worldwide. Most febrile infants younger than 3 months have nonbacterial causes of fever, and these children are frequently clinically indistinguishable from those with serious bacterial infections (SBIs) (including bacterial meningitis, bacteremia, and urinary tract infections).

The evaluation of well-appearing febrile infants continues to be challenging and controversial for clinicians. This is particularly true for infants younger than 3 months because although the risks of bacteremia and bacterial meningitis are low in those with normal routine screening laboratory test results (eg, complete blood cell counts and urinalyses), the outcomes of bacteremia and meningitis could be devastating.1 The need for performing routine lumbar punctures in well-appearing febrile infants younger than 3 months is also part of the controversy.1 The essence of the controversy is that no definitive clinical criteria or laboratory screening tests reliably exclude SBI, and blood cultures have a not-inconsequential rate of false-positive and false-negative results.2 Clinically apparent viral syndromes such as bronchiolitis reduce but do not exclude the possibility of SBI,3 and although clinical prediction rules can help identify those infants with bacterial meningitis, they are not perfect, particularly in the youngest infants.4

Figures in this Article

Sign in

Create a free personal account to sign up for alerts, share articles, and more.

Purchase Options

• Buy this article
• Subscribe to the journal

First Page Preview

View Large
First page PDF preview

Figures

Place holder to copy figure label and caption
Figure.
Gene Expression Patterns Discriminate Viral vs Bacterial Infections

A, Set of 35 genes that discriminates patients with viral infections (influenza A; green) and bacterial infections (Escherichia coli and Streptococcus pneumoniae; red). The discriminative pattern is shown by the gene expression patterns in the heat map (red indicates overexpressed genes; blue, underexpressed genes). B, The diagnostic signature was tested in an independent set of patients that confirmed its accuracy. K-NN indicates nearest neighbor algorithm.

Graphic Jump Location

Tables

References

Correspondence

CME
Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.
Submit a Comment

Multimedia

Some tools below are only available to our subscribers or users with an online account.

Sign in

Create a free personal account to sign up for alerts, share articles, and more.

Purchase Options

• Buy this article
• Subscribe to the journal

Related Content

Customize your page view by dragging & repositioning the boxes below.

Articles Related By Topic
Related Collections
PubMed Articles
Unmasking an obstinate fever. Isr Med Assoc J 2014;16(5):326-8.
Clinical problem-solving. A creeping suspicion. N Engl J Med 2014;371(1):68-73.
Jobs
JAMAevidence.com

The Rational Clinical Examination
Clinical Scenarios

The Rational Clinical Examination
Patient Scenario

brightcove.createExperiences();