Lyons evaluated modifications of the Boston and Philadelphia criteria for evaluating well-appearing infants with fever. The criteria can help to select patients for outpatient management. The authors are from the Herpes Simplex Virus Study Group of the Pediatric Emergency Medicine Collaborative Research Committee.
Patient selection: well-appearing infant from 29 to 60 days of age with fever
Parameters:
(1) WBC count in peripheral blood per microliter
(2) WBC count in the cerebrospinal fluid per high power field
(3) urine findings
(4) CSF Gram stain result
Parameter
Modified Boston
Modified Philadelphia
WBC count from blood
>= 20,000 per µL
>= 15,000 per µL
WBC count from CSF
>= 10 per hpf
>= 8 per hpf
urine findings
> 10 WBC per hpf OR positive urinalysis
> 10 WBC per hpf OR positive urinalysis
CSF Gram stain
NA
positive
where:
• If microscopic examination of the urine is performed, then use the urine WBC count. Else use urinalysis.
Invasive Bacterial Infection
Modified Boston
Modified Philadelphia
sensitivity
0.67
0.72
specificity
0.59
0.46
The authors concluded that neither modified score performed well. Performance of the original criteria was not assessed. Performance of the scores depends on sticking to the selection criteria of the infant being well-appearing.
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