{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,9]],"date-time":"2026-07-09T11:29:43Z","timestamp":1783596583794,"version":"3.55.0"},"reference-count":33,"publisher":"American Academy of Pediatrics (AAP)","issue":"6","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2018,12,1]]},"abstract":"<jats:sec><jats:title\/><\/jats:sec><jats:sec><jats:title>OBJECTIVES:<\/jats:title><jats:p>To evaluate the Rochester and modified Philadelphia criteria for the risk stratification of febrile infants with invasive bacterial infection (IBI) who do not appear ill without routine cerebrospinal fluid (CSF) testing.<\/jats:p><\/jats:sec><jats:sec><jats:title>METHODS:<\/jats:title><jats:p>We performed a case-control study of febrile infants \u226460 days old presenting to 1 of 9 emergency departments from 2011 to 2016. For each infant with IBI (defined as a blood [bacteremia] and\/or CSF [bacterial meningitis] culture with growth of a pathogen), controls without IBI were matched by site and date of visit. Infants were excluded if they appeared ill or had a complex chronic condition or if data for any component of the Rochester or modified Philadelphia criteria were missing.<\/jats:p><\/jats:sec><jats:sec><jats:title>RESULTS:<\/jats:title><jats:p>Overall, 135 infants with IBI (118 [87.4%] with bacteremia without meningitis and 17 [12.6%] with bacterial meningitis) and 249 controls were included. The sensitivity of the modified Philadelphia criteria was higher than that of the Rochester criteria (91.9% vs 81.5%; P = .01), but the specificity was lower (34.5% vs 59.8%; P &amp;lt; .001). Among 67 infants &amp;gt;28 days old with IBI, the sensitivity of both criteria was 83.6%; none of the 11 low-risk infants had bacterial meningitis. Of 68 infants \u226428 days old with IBI, 14 (20.6%) were low risk per the Rochester criteria, and 2 had meningitis.<\/jats:p><\/jats:sec><jats:sec><jats:title>CONCLUSIONS:<\/jats:title><jats:p>The modified Philadelphia criteria had high sensitivity for IBI without routine CSF testing, and all infants &amp;gt;28 days old with bacterial meningitis were classified as high risk. Because some infants with bacteremia were classified as low risk, infants discharged from the emergency department without CSF testing require close follow-up.<\/jats:p><\/jats:sec>","DOI":"10.1542\/peds.2018-1879","type":"journal-article","created":{"date-parts":[[2018,11,13]],"date-time":"2018-11-13T08:26:19Z","timestamp":1542097579000},"source":"Crossref","is-referenced-by-count":44,"title":["Risk Stratification of Febrile Infants \u226460 Days Old Without Routine Lumbar Puncture"],"prefix":"10.1542","volume":"142","author":[{"given":"Paul L.","family":"Aronson","sequence":"first","affiliation":[{"name":"Departments of Pediatrics and"},{"name":"Emergency Medicine, Yale School of Medicine, and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marie E.","family":"Wang","sequence":"additional","affiliation":[{"name":"Division of Pediatric Hospital Medicine, Lucile Packard Children\u2019s Hospital Stanford and Department of Pediatrics, School of Medicine, Stanford University, Palo Alto, California;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eugene D.","family":"Shapiro","sequence":"additional","affiliation":[{"name":"Departments of Pediatrics and"},{"name":"Department of Epidemiology of Microbial Diseases, Yale University, New Haven, Connecticut;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Samir S.","family":"Shah","sequence":"additional","affiliation":[{"name":"Divisions of Infectious Diseases and"},{"name":"Hospital Medicine, Cincinnati Children\u2019s Hospital Medical Center and Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, Ohio;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adrienne G.","family":"DePorre","sequence":"additional","affiliation":[{"name":"Divisions of Hospital Medicine and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Russell J.","family":"McCulloh","sequence":"additional","affiliation":[{"name":"Divisions of Hospital Medicine and"},{"name":"Infectious Diseases, Department of Pediatrics, Children\u2019s Mercy Hospital, Kansas City, Missouri;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christopher M.","family":"Pruitt","sequence":"additional","affiliation":[{"name":"Division of Pediatric Emergency Medicine, Department of Pediatrics, University of Alabama at Birmingham, Birmingham, Alabama;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sanyukta","family":"Desai","sequence":"additional","affiliation":[{"name":"Hospital Medicine, Cincinnati Children\u2019s Hospital Medical Center and Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, Ohio;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lise E.","family":"Nigrovic","sequence":"additional","affiliation":[{"name":"Division of Emergency Medicine, Boston Children\u2019s Hospital and Department of Pediatrics, Harvard Medical School, Harvard University, Boston, Massachusetts;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Richard D.","family":"Marble","sequence":"additional","affiliation":[{"name":"Division of Emergency Medicine, Ann and Robert H. Lurie Children\u2019s Hospital of Chicago and Feinberg School of Medicine, Northwestern University, Chicago, Illinois;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rianna C.","family":"Leazer","sequence":"additional","affiliation":[{"name":"Division of Hospital Medicine, Department of Pediatrics, Children\u2019s Hospital of The King\u2019s Daughters, Norfolk, Virginia;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sahar N.","family":"Rooholamini","sequence":"additional","affiliation":[{"name":"Division of Hospital Medicine, Seattle Children\u2019s Hospital and Department of Pediatrics, School of Medicine, University of Washington, Seattle, Washington;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laura F.","family":"Sartori","sequence":"additional","affiliation":[{"name":"Division of Pediatric Emergency Medicine, Monroe Carell Jr Children\u2019s Hospital at Vanderbilt and Department of Pediatrics, School of Medicine, Vanderbilt 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