Abstract
To assess the effects of obtaining a blood culture on the subsequent diagnostic and therapeutic management of young febrile children without an evident focus of bacterial infection, we carried out a randomized controlled clinical trial of this procedure in 146 children 3 to 24 months of age who presented to our emergency department with an unexplained temperature of 39.0 degrees C or higher. Random assignment to either have (67 children) or not have (79) a blood sample taken for culture resulted in groups equivalent in age, sex, weight, socioeconomic status, temperature at enrolment and laboratory test results. No differences were detected in the rates of subsequent hospital admission, outpatient visits, determination of complete blood count or other blood tests, urinalysis or urine culture, chest or other roentgenography, or administration of antibiotics or other medications. Knowledge of the absence of such differences should be helpful in evaluating the relative benefits and costs of blood culture for young febrile children.
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Selected References
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- Baron M. A., Fink H. D. Bacteremia in private pediatric practice. Pediatrics. 1980 Aug;66(2):171–175. [PubMed] [Google Scholar]
- Bennish M., Beem M. O., Ormiste V. C-reactive protein and zeta sedimentation ratio as indicators of bacteremia in pediatric patients. J Pediatr. 1984 May;104(5):729–732. doi: 10.1016/s0022-3476(84)80953-1. [DOI] [PubMed] [Google Scholar]
- Bratton L., Teele D. W., Klein J. O. Outcome of unsuspected pneumococcemia in children not initially admitted to the hospital. J Pediatr. 1977 May;90(5):703–706. doi: 10.1016/s0022-3476(77)81231-6. [DOI] [PubMed] [Google Scholar]
- Carroll W. L., Farrell M. K., Singer J. I., Jackson M. A., Lobel J. S., Lewis E. D. Treatment of occult bacteremia: a prospective randomized clinical trial. Pediatrics. 1983 Nov;72(5):608–612. [PubMed] [Google Scholar]
- Dershewitz R. A., Wigder H. N., Wigder C. M., Nadelman D. H. A comparative study of the prevalence, outcome, and prediction of bacteremia in children. J Pediatr. 1983 Sep;103(3):352–358. doi: 10.1016/s0022-3476(83)80402-8. [DOI] [PubMed] [Google Scholar]
- Marshall R., Teele D. W., Klein J. O. Unsuspected bacteremia due to Haemophilus influenzae: outcome in children not initially admitted to hospital. J Pediatr. 1979 Nov;95(5 Pt 1):690–695. doi: 10.1016/s0022-3476(79)80712-x. [DOI] [PubMed] [Google Scholar]
- McCarthy P. L., Grundy G. W., Spiesel S. Z., Dolan T. F., Jr Bacteremia in children: an outpatient clinical review. Pediatrics. 1976 Jun;57(6):861–868. [PubMed] [Google Scholar]
- McGowan J. E., Jr, Bratton L., Klein J. O., Finland M. Bacteremia in febrile children seen in a "walk-in" pediatric clinic. N Engl J Med. 1973 Jun 21;288(25):1309–1312. doi: 10.1056/NEJM197306212882501. [DOI] [PubMed] [Google Scholar]
- Murray D. L., Zonana J., Seidel J. S., Yoshimori R. N., Imagawa D. T., St Geme J. W., Jr Relative importance of bacteremia and viremia in the course of acute fevers of unknown origin in outpatient children. Pediatrics. 1981 Aug;68(2):157–160. [PubMed] [Google Scholar]
- Pai C. H., Sorger S. Enhancement of recovery of Neisseria meningitidis by gelatin in blood culture media. J Clin Microbiol. 1981 Jul;14(1):20–23. doi: 10.1128/jcm.14.1.20-23.1981. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Schwartz R. H., Wientzen R. L., Jr Occult bacteremia in toxic-appearing, febrile infants. A prospective clinical study in an office setting. Clin Pediatr (Phila) 1982 Nov;21(11):659–663. doi: 10.1177/000992288202101103. [DOI] [PubMed] [Google Scholar]
- Teele D. W., Pelton S. I., Grant M. J., Herskowitz J., Rosen D. J., Allen C. E., Wimmer R. S., Klein J. O. Bacteremia in febrile children under 2 years of age: results of cultures of blood of 600 consecutive febrile children seen in a "walk-in" clinic. J Pediatr. 1975 Aug;87(2):227–230. doi: 10.1016/s0022-3476(75)80584-1. [DOI] [PubMed] [Google Scholar]
- Waskerwitz S., Berkelhamer J. E. Outpatient bacteremia: clinical findings in children under two years with initial temperatures of 39.5 degrees C or higher. J Pediatr. 1981 Aug;99(2):231–233. doi: 10.1016/s0022-3476(81)80458-1. [DOI] [PubMed] [Google Scholar]
