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Early postoperative fever workup in children: utilization and utility

Kristine S Corkum1, Catherine J Hunter1, Julia E Grabowski1

  • 1Division of Pediatric Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL; Feinberg School of Medicine, Northwestern University, Chicago, IL.

Journal of Pediatric Surgery
|July 12, 2017
PubMed

Insights

Early postoperative fever is common in children after surgery. Diagnostic tests for infection are often unnecessary, as fever rarely indicates an infectious source in these patients.

Area of Science:

  • Pediatric Surgery
  • Infectious Disease
  • Clinical Outcomes

Background:

  • Early postoperative fever is a frequent occurrence in pediatric surgical patients.
  • Limited data exists on the diagnostic workup and yield of fever investigations in children compared to adults.
  • Understanding fever patterns and test utility is crucial for appropriate clinical management.

Purpose of the Study:

  • To determine the incidence of early postoperative fever in pediatric surgical patients.
  • To evaluate the utilization and diagnostic yield of common laboratory and imaging tests ordered for fever.
  • To inform evidence-based guidelines for fever workup in this population.

Main Methods:

  • Retrospective analysis of 6943 pediatric surgical patients undergoing elective inpatient/observational surgery (2011-2015).
  • Early fever defined as temperature >38.0°C within two days post-procedure.
  • Data collected on blood cultures, urinalysis, urine cultures, chest radiographs, and respiratory viral panels.

Main Results:

  • 30.6% of patients developed early postoperative fever.
  • Positive findings were low: blood cultures (0.69%), chest radiographs (3.0% infectious).
  • Urinalysis and urine cultures showed higher positivity but were often associated with urinary catheter use.

Conclusions:

  • Early postoperative fever is common in pediatric surgical patients and seldom linked to an infection.
  • Selective application of diagnostic workup for fever is recommended.
  • Current testing strategies may be overutilized without significant diagnostic benefit.
Abstract

Keywords:
ChildrenFeverInfectionWorkup

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