ERs often skip tests for young kids with fever

Babies and toddlers who arrive at the ER with an unexplained fever often receive no kind of diagnostic test to get at the source of the high temperature, a new study finds.

Whether that's a bad or good thing is not clear, according to the researchers.

But in some cases, the study found, ER doctors prescribe antibiotics without testing to confirm whether or not the child has a bacterial infection. And that could potentially lead to antibiotic overuse.

Babies and children younger than three often develop fevers that have no obvious cause. And it's estimated that fevers account for up to one-quarter of young children's ER visits.

Fevers in very young infants are considered a sign of a potentially dangerous bacterial infection.

But doctors have long debated how to best manage unexplained fevers in children between the ages of three months and three years, according to Dr. Alan E. Simon, a researcher at the National Center for Health Statistics who led the new study.

Since babies these days get the pneumococcal and Hib (Haemophilus influenza type B) vaccines, the odds of a serious bacterial infection, such as a blood infection, are low. So, at least some experts say, a blood test would usually be unnecessary in a vaccinated child with a fever.

On the other hand, a urine test for the much more common cause of fevers - urinary tract infections (UTI) - might be in order.

But until now, no studies had looked at what's actually going on in U.S. ERs.

For their study, Simon's team examined records from a national sample of ERs for 2006 to 2008.

They found that in cases where a child ages three months to three years had a fever with no obvious cause, doctors ordered no diagnostic test 59 percent of the time.

Even among girls with a fever higher than 102.2 degrees Fahrenheit - a group considered at higher risk for UTIs - urine tests were ordered only 40 percent of the time.

Overall, urine tests were done in 17 percent of cases, while blood tests were done in about 20 percent.

That raises the possibility that urine tests were underused, at least in girls, while blood tests were overused, Simon's team writes.

But, Simon told Reuters Health, it's not possible to tell for sure.

"Clinical judgment always comes into it," he explained.

And what guidelines exist are not universal, or necessarily hard-and-fast.

The American Academy of Pediatrics, for instance, used to recommend that all children ages two months to two years with an unexplained fever get a urine test. But its latest guidelines, set this year, leave more room for case-by-case decisions.

Some other experts, meanwhile, recommend that urine tests be done whenever a girl or uncircumcised boy younger than two years, or a circumcised boy younger than six months, has a fever with no known cause (because they are at increased risk of a UTI).