Febrile Infants: Aligning Science, Guidelines, and Cost Reduction With Quality of Individualized Care

Abstract

* Abbreviations: CBC — : complete blood cell count EB-CPM — : evidence based care process model PROS — : Pediatric Research in Office Settings SBI — : serious bacterial illness WBC — : white blood cell count In the decade since Ken Roberts wrote about an ending to the 30-year febrile infant odyssey,1 the quest for optimal management continues. A recent evidence report by the Agency for Healthcare Research and Quality leaves the question unanswered,2 and an American Academy of Pediatrics subcommittee is actively addressing this issue. The study by Byington et al3 in this issue of Pediatrics makes several important contributions. This study confirms the incidence of the most serious bacterial illnesses (SBIs), meningitis (0.3%) and bacteremia (2.0%).3 These findings are consistent with the large community-based study by the Pediatric Research in Office Settings (PROS) network (0.5% and 1.8%, respectively)4 and those from large emergency department and network studies (bacterial meningitis: 0.3%–0.7%; bacteremia: 1.9%–2.2%).5,6 The infrequent occurrence makes this condition best-studied in large integrated systems or in collaborative research networks. However, the number of large studies is limited, and only PROS included a national community-based sample. The carefully developed evidence-based care process model (EB-CPM) used in the study by Byington et al3 was based on extensive research. The entry point for the study was “well appearance.” Studies on the ability to judge clinical appearance are limited, but there … Address correspondence to Robert H. Pantell, MD, Box 0503, University of California San Francisco, San Francisco, CA 94143-0503