🌡️ Fever · Occult Bacteremia & SBI Risk · Infant & Child Tool

Schwartz Clinical Handbook — Chapter 33 · Rochester Criteria · Boston/Philadelphia Protocols · UTI · Bacteremia · Meningitis · Pneumonia

Select fever height, age, immunization status, ill appearance, and lab cutoff clues → estimate risk of serious bacterial infection (SBI) and guide management (urine testing, blood culture, lumbar puncture, empiric antibiotics).
⚠️ Red flags: ill appearance, age <28 days, petechial/purpuric rash → admit, IV antibiotics, LP.

📋 Step 1 — Fever & risk stratification
📌 SBI risk & workup
📖 Schwartz Ch 33

Select age, fever height, immunization status (PCV13, Hib), ill appearance, and lab criteria (WBC, band count, urinalysis, CSF) → system applies Rochester / Boston / Philadelphia low‑risk criteria and recommends outpatient observation vs admission + empiric antibiotics.

✔️ Low risk: well‑appearing, age >28 days, normal WBC/UA, reliable follow‑up.
✔️ High risk: toxic appearance, age <28 days, bandemia, pyuria, CSF pleocytosis.
✔️ UTI most common SBI in 2‑24 months (girls, uncircumcised boys).
✔️ Pneumococcal conjugate vaccine has reduced occult bacteremia.
📘 Schwartz pearls (Chapter 33)
• Urine testing in all febrile infants 0‑60 days.
• LP indicated if age <28 days or ill appearing / meningeal signs.
• Empiric antibiotics: ampicillin + gentamicin/cefotaxime (neonates), ceftriaxone (1‑3 months).
• Antipyretics do not reduce risk of SBI.