Date of Award

5-20-1982

Document Type

Open Access Thesis

Degree Name

Medical Doctor (MD)

First Advisor

Jerome Klein, M.D.

Second Advisor

Raymond Karasic, M.D.

Abstract

The hospital records of all outpatient infants 92 days of age or less with rectal temperature ≥ 100° F and/or chief complaint of fever who presented to Boston City Hospital's Pediatric Walk-In Clinic (PWIC) in the year 1981 were reviewed. There were 187 total study visits. The rectal temperature (T) in the PWIC was ≥ 100°F in 132 visits; half of these visits (66) were for T ≥ 101°F. The number of patients presenting with T ≥ 101°F increased with each month of age. The majority of study visits (56.1%) were for mild, self-limited illnesses; 14.4% of all visits were for serious illnesses (pneumonia, meningitis, bacteremia, urinary tract infection, and septic arthritis/osteomyelitis). The percentage of patients with serious illness was significantly greater in those visits for T > 101°F (31.8%) versus those for T < 101°F (4.2%). Age less than one month was a risk factor for serious illness in febrile infants (T ≥ 100°F in the PWIC): 30.4% of febrile infants ≤ 30 days old had serious illness versus 14.7% of febrile infants 31-92 days old. Serious illness was significantly more prevalent when the WBC count was ≥ 10,000/mm3, percent PMNs was ≥ 50, or absolute PMNs was ≥ 5000/mm3. Of these parameters, WBC ≥ 10,000/mm3 was the most sensitive (85.7%) indicator of serious illness. In this study, 42.2% of patients ≤ 30 days old with T ≥ 100°F and WBC ≥ 10000/mm3 or 31-92 days old with T ≥ 101°F and WBC ≥ 10,000/mm3 had serious illness; therefore a full evaluation for sepsis should be considered in any infant fulfilling these screening criteria.

Comments

This is an Open Access Thesis.

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