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Published on: January 17, 2011
Pediatric resident management of the young febrile child
Insights
Pediatric residents
Area of Science:
- Pediatrics
- Infectious Disease
- Medical Education
Background:
- Identifying serious illness in febrile children under two years old presents diagnostic challenges for physicians, particularly pediatric residents.
- Conflicting clinical guidelines complicate the management of febrile infants and young children.
Purpose of the Study:
- To survey pediatric house staff practices in managing febrile children under two years old.
- To assess resident confidence and perceived need for protocols in managing febrile children of varying ages.
Main Methods:
- A written questionnaire was administered to 35 pediatric house staff (PL-1, PL-2, PL-3) at a university-affiliated hospital.
- Survey focused on practices for children under two years with rectal temperatures above 101°F (38.3°C).
Main Results:
- House staff uniformly recognized the importance of age, fever degree, and lab data, but varied on specific data significance.
- Laboratory test utilization decreased with increasing patient age, with greater reliance on clinical judgment for older children.
- Residents expressed highest confidence and perceived greatest need for protocols in managing infants under three months old.
Conclusions:
- Pediatric house staff's approach to febrile children varies by age, with a trend towards reduced laboratory testing and increased clinical judgment in older infants.
- Confidence and perceived need for formal protocols are highest for the youngest febrile infants, suggesting a need for age-specific guidelines and training.
Abstract:
Identifying the febrile child at risk for serious illness continues to challenge physicians, especially since conflicting guidelines exist for identification and management. This situation poses a special problem for the pediatrician-in-training. In this study the 35 PL-1, P1-2, and PL-3 pediatric house staff of a university-affiliated hospital were surveyed by written questionnaire regarding their practices in dealing with children of less than two years with rectal temperature above 101 degrees F (38.3 degrees C). Uniform replies were received from all house staff concerning the significance of patient age, degree of fever, and laboratory data, although there were some differences of opinion regarding the importance of specific data. All three resident levels tended to reduce the number of laboratory tests obtained as patient age increased, with emphasis placed on clinical impression of illness in assessing the older febrile child. Although the house staff indicated that they were satisfied with their handling of the febrile child, the PL-3s were only marginally more satisfied than the PL-1s and PL-2s. In general, the house staff had most confidence in handling the patient under three months of age, for whom it was generally felt that extensive laboratory evaluations and active management were indicated. The perception of the need for a formal protocol was also greatest for this youngest age group and decreased in importance with age.
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