{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,15]],"date-time":"2025-12-15T00:28:22Z","timestamp":1765758502165},"reference-count":16,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2017,10,30]],"date-time":"2017-10-30T00:00:00Z","timestamp":1509321600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J Paediatrics Child Health"],"published-print":{"date-parts":[[2018,3]]},"abstract":"Aim<\/jats:title>To assess adherence to the Iocal guideline (LG<\/jats:styled-content>) for the management of fever in infants under 3 months and whether the application of a risk\u2010stratified protocol (RSP<\/jats:styled-content>) to this population would miss any serious bacterial infections (SBI<\/jats:styled-content>) compared to current practice (CP<\/jats:styled-content>) and LG<\/jats:styled-content>.<\/jats:p><\/jats:sec>Methods<\/jats:title>All presentations to the authors\u2019 Emergency Department of infants 0\u20133 months with fever from 1 July 2015 to 28 April 2016 were included (n<\/jats:italic>\u2009=\u2009219), along with a detailed analysis of CP<\/jats:styled-content>. The initial history, examination and pathology results were applied to the LG<\/jats:styled-content> and RSP<\/jats:styled-content> to assess what changes in management would occur. The primary end point was a missed SBI<\/jats:styled-content>, with secondary outcomes measuring the number of invasive procedures performed, antibiotics prescribed and admissions.<\/jats:p><\/jats:sec>Results<\/jats:title>Adherence to the LG<\/jats:styled-content> was 83% with three missed SBI<\/jats:styled-content>s. Strict adherence would have resulted in eight missed SBI<\/jats:styled-content>s. This indicates that both warranted and unwarranted variation exists in current clinical practice. Application of the RSP<\/jats:styled-content> showed no missed SBIs<\/jats:styled-content> but, compared to CP<\/jats:styled-content>, indicates a statistically significant increase in admissions and full septic screens (admissions 95% vs. 83%, P<\/jats:italic>\u2009<\u20090.05; full septic screens 82% vs. 72%, P<\/jats:italic>\u2009<\u20090.05). Chest X\u2010rays were infrequently requested (10%) and the validity of use in this group warrants further study.<\/jats:p><\/jats:sec>Conclusion<\/jats:title>An ad hoc<\/jats:italic> risk\u2010stratified practice already exists at the authors\u2019 institution, and application of an RSP<\/jats:styled-content> did not miss any SBIs<\/jats:styled-content>. Adoption and implementation of a formal RSP<\/jats:styled-content> is currently being formulated.<\/jats:p><\/jats:sec>","DOI":"10.1111\/jpc.13743","type":"journal-article","created":{"date-parts":[[2017,10,30]],"date-time":"2017-10-30T10:06:36Z","timestamp":1509357996000},"page":"272-278","update-policy":"http:\/\/dx.doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Fever under 3 months and the full septic screen: Time to think again? A retrospective cohort study at a tertiary\u2010level paediatric hospital"],"prefix":"10.1111","volume":"54","author":[{"given":"Patrick","family":"Aldridge","sequence":"first","affiliation":[{"name":"Sydney Children's Hospital Sydney Children's Hospitals Network Sydney New South Wales Australia"},{"name":"School of Women's and Children's Health University of New South Wales Sydney New South Wales Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Arjun","family":"Rao","sequence":"additional","affiliation":[{"name":"Sydney Children's Hospital Sydney Children's Hospitals Network Sydney New South Wales Australia"},{"name":"School of Women's and Children's Health University of New South Wales Sydney New South Wales Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rebecca","family":"Sethumadavan","sequence":"additional","affiliation":[{"name":"Sydney Children's Hospital Sydney Children's Hospitals Network Sydney New South Wales Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nancy","family":"Briggs","sequence":"additional","affiliation":[{"name":"School of Women's and Children's Health University of New South Wales Sydney New South Wales Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2017,10,30]]},"reference":[{"key":"e_1_2_8_2_1","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2013-1820"},{"key":"e_1_2_8_3_1","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2014-1382"},{"key":"e_1_2_8_4_1","doi-asserted-by":"publisher","DOI":"10.1097\/PEC.0b013e3181fe90d1"},{"key":"e_1_2_8_5_1","doi-asserted-by":"publisher","DOI":"10.1111\/jpc.13212"},{"key":"e_1_2_8_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0196-0644(05)80991-6"},{"key":"e_1_2_8_7_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM199311113292001"},{"key":"e_1_2_8_8_1","first-page":"1","volume-title":"Evi. 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