MANAGEMENT OF THE FEBRILE CHILD - A SURVEY OF PEDIATRIC AND EMERGENCY-MEDICINE RESIDENCY DIRECTORS

We conducted a survey to determine whether there is uniformity in the training of residents regarding the management of febrile children. One hundred forty-three (62%) of 231 pediatric and 39 (53%) of the 73 emergency medicine residency directors responded. There was no uniformity in the definition of a fever. Ninety-nine percent of the pediatric and 82% of the emergency medicine residency directors teach that all febrile infants < 4 weeks of age should be hospitalized (P < 0.0001). Forty-six percent of residency directors teach that a lumbar puncture should be performed for all children < 12 months of age with their first febrile convulsion. Thirty percent of pediatric and 62% of emergency medicine residency directors teach that a blood culture should be obtained from a child with fever without source who is younger than 24 months of age (P < 0.0005). Nonspecific tests are taught to be used to determine which febrile child should have a blood culture as follows: white blood cell count, 50%; differential, 20%; erythrocyte sedimentation rate, 13%; and C-reactive protein, 2%. There was little uniformity of teaching regarding the approach to the febrile child and there were significant differences in training by specialty.