Tactics of the doctor at the first meeting with a child with high body temperature – fever

Hidden bacteremia in children with fever who do not have local symptoms of the disease is a serious problem. The frequency of bacteremia in these children is quite high – from 4 to 10%. The consequences of bacteremia are dangerous, – 5% of patients develop meningitis and 5% have other serious bacterial infections. From the data provided by Baron, it clearly follows that latent bacteremia is a real problem for clinics and clinics and ambulance doctors.

You can identify bacteremia by conducting blood culture for sterility at the first visit to the doctor. Repeated call of such a patient when receiving positive results of bacteriological blood tests will allow to diagnose meningitis and other serious complications much earlier than under other conditions. Immediately initiated therapy prevents the development of additional complications.

Early treatment of patients in the outpatient setting after receiving the results of blood culture, it seems to us, reduces the incidence of meningitis and other serious infectious diseases, but does not reduce it to zero.

There are various approaches to the treatment of patients with fever without local symptoms. In the literature, you can find supporters of each of them. At one extreme are the empiricists (“pure clinicians”), who believe that it is necessary to clinically evaluate the condition of the child and on this basis decide the question of treatment. At the other extreme are doctors who suggest starting therapy only after a comprehensive laboratory examination.

Sometimes it happens that in a dispute between the parties, emotions and feelings prevail over a thorough analysis of the available data. Accurately identify all patients with bacteremia is impossible, although some argue otherwise. There is only a small group of patients in serious condition who are highly likely to develop bacteremia.

Waskerwitz believes that according to anamnesis and examination, including a functional assessment of the child’s state of how he eats, drinks, sleeps, plays, a small group of children can be identified who look so good, despite the temperature of 39.5 ° C and higher. that have very little risk of developing bacteremia. However, this group included only 25% of the total number of patients, and the author, unfortunately, did not provide information about the average temperature and its fluctuations in children in good condition without bacteremia. If all patients had a body temperature below 40 ° C, then a sufficiently accurate prediction could be made only by measuring body temperature.

local_offerevent_note February 21, 2019

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