Continuing on with the anecdotal evidence of FOAM resources improving (at least changing) my day to day clincal work:
I have a love/hate relationship with paediatric febrile presentations: on one hand, the majority of them are benign and a little parental reassurance goes a long way. On the other hand, they can be the harbinger of very morbid disease process and our paediatric colleagues continue to seem obsessed with toddler wee which can be quite frustrating (and seemingly worthless) to obtain sometimes.....
Here are some recent blogs/articles/tips to add confidence to your assessment and quicken the dispostion of this large group of patients in our departments:
- risk of serious bacterial infection is VERY low in the well looking, immunized child:
- tympanic temperature recording is proven to be both specific and sensitive, dont need to stick things up kids bums and it was better then under the arm. Interestingly, the infrared recording of the temporal artery was also very sensitive/specific (I previously thought that was all just witchcraft..)
- great tip on getting a quick wee from those non-compliant little toddlers, boys only, sorry girls, still difficult. (jeez, learn to pee on demand dam it!!)
In my N=4, I have not had to proceed past step 2, so be ready
- Procalcitonin is fraught with tainted evidence and conflicts of interest.... I choose to ignore anyone who wants this test at the moment... (provided it is not my paediatrician wife who I am bound to obey.... silly vows!)
- Why is the urine sample so important:
UTI's are common (5-8% of Fever without source), though few progress to SBI.
renal scarring/CKD post recurring febrile UTI is controversal at best.
- How my practice has changed: risk stratify, obtain urine sample, treat accordingly, always close follow up.
And as per the last post, I promise you I have done no extra work outside of my regular persual of FOAMed, I have read none of the publications in full on this topic, that I can promise you. (I have no business attmepting to critically appraise the literature, leave it to the evolving number of experts out there.)
drink it up. Scott