Fever without a source in children: international comparison of guidelines

Area of Science:

• Pediatrics
• Infectious Diseases
• Clinical Guideline Development

Background:

• Fever without source (FWS) in children presents a significant diagnostic challenge.
• Existing clinical guidelines aim to differentiate self-limiting from serious infections in FWS cases.
• A comparative analysis of current FWS guidelines is lacking.

Purpose of the Study:

• To compare existing guidelines for managing fever without source in children.
• To identify consistencies and discrepancies in definitions, diagnostic, and therapeutic recommendations.
• To inform future guideline harmonization and research.

Main Methods:

• A comparative review of secondary care FWS guidelines from high-income countries.
• Literature search included guidelines from national/regional pediatric or emergency care associations.
• Guidelines were available in English or Dutch.

Main Results:

• Ten guidelines from five countries were analyzed, with varied pediatric age ranges.
• For infants <1 month, most guidelines recommended extensive lab testing and antibiotics.
• Recommendations diverged for infants aged 1-3 months and >3 months, especially for urine cultures and selective antibiotic use.

Conclusions:

• Existing FWS guidelines show broad consistency, particularly for neonates.
• Variations are most notable in age stratification and recommendations for infants aged 1-3 months and older.
• Harmonizing guideline development and future research is facilitated by understanding these variations.