who return to baseline in the ED. An article published in the Annals
of Emergency Medicine in 2017 found that the incidence of bacterial
or herpetic meningitis/encephalitis in more than 1 million children
evaluated for complex febrile seizures, was the same as the rest of the
population. 3 This means that if the children aren’t meningitic appearing,
The duration of fever is another common cause of concern, and
there are numerous approaches to the child with prolonged fever.
The problem is that there’s little agreement on how long is too long.
Once again, this obviously pertains to the well-appearing child.
Perhaps most common in academic pediatric EDs is the initiation of
a laboratory and radiologic workup in the setting of five days of documented fever > 100.4 degrees F.
Although viral illnesses are still by far the most common cause, you
should begin to consider the possibilities of other issues including bacteremia (i.e., bacteria in the blood), pneumonia, urinary tract infections,
leukemia and inflammatory disorders including Kawasaki disease.
Another common question is whether or not the absence of vaccines increases the risk for bacterial infections. Let’s be super clear
about this: All vaccines reduce the risk of serious and invasive bacterial or viral infections.
A 2015 evaluation of the 13-valent pneumococcal conjugate vaccine, which covers 13 different strains of the bacterial Streptococcus
pneumoniae, dramatically reduced the incidence of invasive pneumococcal disease (e.g., meningitis, bacteremia, pneumonia). In children,
rates of reduction varied from 64–93% compared to the prior period
where only seven types of pneumococcal strains were covered, and in
adults, the decline was 12–72%. 4, 5
There are a select few groups of children for whom the presence
of fever suggests the need for urgent evaluation, though the need for
emergent prehospital care is likely limited. Patients under two months
of age, those with cancer and certain blood disorders, such as sickle cell
disease, and those with complex medical needs are at higher risk for
serious bacterial infections, and require urgent evaluation in the ED.
Patients may utilize EMS for transport, though interventions are
rarely needed. Certainly, fever in the setting of evidence of shock (i.e.,
end-organ hypoperfusion) should increase our concern for sepsis, and
fluid resuscitation ( 20 mL/kg), blood sugar evaluation and oxygen
administration should be considered.
Table 3: Overview of thermometer types used for prehospital care
Brand/model Welch Allyn Sure Temp Plus 690 Exergen Temporal Scanner Hyology MD-H4 Braun Thermoscan PRO 6000 ADC Adtemp 424
Type Electronic with disposable probe Temporal artery infrared scan Distant infrared scan Tympanic infrared Tympanic infrared
and/or rectal Temporal (forehead) Non-contact Tympanic (ear) Tympanic (ear)