Original articleClinical practice managementACR Appropriateness Criteria Fever Without Source or Unknown Origin—Child
Section snippets
Introduction/Background
A febrile pediatric patient, especially an infant, represents a dilemma for a primary care physician. The definition of fever is generally regarded as a rectal temperature of ≥38°C 1, 2, 3. Oral temperatures are less reliable in infants and young children, although they are the usual method of measuring temperature in older children and adults. The cause of fever in a pediatric patient can often be determined from history, physical examination, and laboratory tests 4, 5, 6, 7, 8, 9. Prior
Summary of Evidence
Of the 79 references cited in the ACR Appropriateness Criteria Fever Without Source—Child document, 73 are categorized as diagnostic references, including 1 well-designed study, 3 good-quality studies, and 16 quality studies that may have design limitations. Additionally, 2 references are categorized as therapeutic references, including 1 well-designed study. There are 54 references that may not be useful as primary evidence. There are 4 references that are meta-analyses.
The 79 references cited
Relative Radiation Level Information
Potential adverse health effects associated with radiation exposure are an important factor to consider when selecting the appropriate imaging procedure. Because there is a wide range of radiation exposures associated with different diagnostic procedures, a relative radiation level (RRL) indication has been included for each imaging examination. The RRLs are based on effective dose, which is a radiation dose quantity that is used to estimate population total radiation risk associated with an
Supporting Documents
For additional information on the ACR Appropriateness Criteria methodology and other supporting documents, go to www.acr.org/ac.
Take-Home Points
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Neonates younger than one month with FWS are a high-risk group; however, the yield of routine chest radiography is low in the absence of respiratory symptoms.
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In a child with FWS, chest radiography should be performed when there is clinical evidence of a respiratory illness and for those with fever ≥39°C or WBC count ≥20,000/mm3.
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In children with neutropenia and FWS, especially those after bone marrow transplantation with persistent fever despite the administration of antibiotics, CT of the chest
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Pediatric Nuclear Medicine: Technical Aspects
2022, Nuclear Medicine and Molecular Imaging: Volume 1-4Pediatric Lower Respiratory Tract Infections: Imaging Guidelines and Recommendations
2022, Radiologic Clinics of North AmericaCitation Excerpt :An extensive search of the medical literature, which includes peer-reviewed systematic reviews/meta-analysis, review articles, evidence-based guidelines, and consensus statements, was performed. In addition to American College of Radiology Appropriateness Criteria for pneumonia in the immunocompetent child,10 Appropriateness Criteria for acute respiratory illness in the immunocompromised patients,11 and Appropriateness Criteria for fever without source or unknown origin–child,12 many other references were utilized in order to generate various clinical scenarios in pediatric patients with LRTI along with corresponding recommended imaging tests (Table 1). To analyze the strength of the references used, strength of recommendation (SORT) was utilized.
The quality of diagnostic guidelines for children in primary care: A meta-epidemiological study
2023, Journal of Paediatrics and Child HealthFever without Source in Children: Six Years Experience of a Children’s Hospital
2022, Gazi Medical Journal
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The ACR seeks and encourages collaboration with other organizations on the development of the ACR Appropriateness Criteria through society representation on expert panels. Participation by representatives from collaborating societies on the expert panel does not necessarily imply individual or society endorsement of the final document.
Dr Safdar has received research funding from GE and has financial interest in Yottalook. The other authors have no conflicts of interest related to the material discussed in this article.