Limitations included:
- Prevalence of bacterial infection was similar to other European publications but higher than in many studies in the United States, primarily due to an increased rate of UTI. (In this study, the authors used a definition of leukocyturia and culture with ≥10,000 cfu/mL.)
- Band count, although part of the Rochester criteria, was not available in some of the centers and not included in analysis. Inclusion of this lab study could have changed the performance of the Rochester criteria.
- The Step-by-Step approach was not compared to other existing criteria.
Bottom Line: In this study, the Step-by-Step approach was very accurate in identifying febrile infants at low risk for invasive bacterial infection, performing better than the Rochester criteria, and may be helpful in evaluation of infants with fever in the emergency department. A cautious approach is warranted for patients with very short fever duration, as they may be missed by ancillary test results.
Citation: Gomez B, Mintegi S, Bressan S, et al. Validation of the “step-by-step” approach in the management of young febrile infants. Pediatrics. 2016;138(2). pic:e20154381.
Carl Galloway, MD, is a hospitalist at Sanford Children’s Hospital in Sioux Falls, S.D.