Kuppermann et al identified predictors of occult pneumococcal bacteremia in febrile children 3 to 36 months of age. These can help identify children who may benefit from more aggressive management. The authors are from the University of California at Davis.
Patient selection: 3 to 36 months of age with temperature >= 39°C (>= 102.2°F)
Parameters:
(1) age in months
(2) temperature in °C
(3) absolute neutrophil count per µL (ANC)
Age
Temperature
ANC
Risk Group
24 - 36 months
39.0 - 39.4°C
NA
1
24 - 36 months
>= 39.5°C
< 10,000 per µL
2
3 - 24 months
>= 39.0°C
< 10,000 per µL
2
24 - 36 months
>= 39.5°C
>= 10,000 per µL
3
3 - 24 months
>= 39.0°C
>= 10,000 per µL
3
where:
• Temperature was not further specified (oral, rectal, tympanic).
• Group 1 appears to be independent of the absolute neutrophil count as listed in Figure 4. I would think that a child with a higher ANC would be at higher risk.
• The groups overlap at 24 months. In the implementation 24-36 was made > 24 to 36.
Risk Group
Percent with Occult Pneumococcal Bacteremia
1
0 - 1%
2
2.5%
3
8%
from Figure 4, page 685
The authors note (page 686) that with immunization to Hemophilus influenzae Type b that >= 90% of occult bacteremia in children 3 to 36 months (referencing Harper and Fleisher).
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