One of the topics that we believe has remained “hot” for decades is how best to evaluate infants with fever. There is the Yale Criteria, the Rochester Criteria, and a number of others—and all, when tested prospectively still are not perfect in identifying who has serious bacterial infection and who doesn’t. That is why a new sequential approach called “Step by Step” has been developed that includes procalcitonin levels as an added feature in determining who needs antibiotic treatment for possible bacterial infection and who doesn’t.
This week, Gomez et al. (peds.2015-4381) validate the Step by Step approach in infants less than 90 days of age who have fever without a localizing source in 11 European pediatric emergency departments in multiple countries. The authors compare the Step by Step sensitivity and specificity and find it to be better than two other known criteria that are popularly used—i.e. the Rochester criteria and the “Lab-score” for identifying patients at low risk of invasive bacterial infection (IBI). So should we start using the Step by Step criteria to determine who needs a lumbar puncture, blood and urine cultures?
Pediatric emergency medicine specialists Drs. Paul Aronson and Mark Neuman (peds.2016-1579) offer their opinion in an accompanying commentary that puts the Step by Step findings in context. Are you using Step by Step or other criteria to make decisions on your febrile infant patients? Share with us your thoughts on this topic by responding to this blog, posting a comment in response to the study, or by chiming in on our Facebook or Twitter links.
