Department of Pediatrics, Tergooi Hospital, Rijksstraatweg 1, 1261 AN, Blaricum, The Netherlands.
Department of Pediatrics, Amsterdam University Medical Centers, Location Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
World J Pediatr. 2023 Feb;19(2):120-128. doi: 10.1007/s12519-022-00611-8. Epub 2022 Oct 26.
Fever without a source (FWS) in children poses a diagnostic challenge. To distinguish a self-limiting infection from a serious infection, multiple guidelines have been developed to aid physicians in the management of FWS. Currently, there is no comparison of existing FWS guidelines.
This comparative review describes consistencies and differences in guideline definitions and diagnostic and therapeutic recommendations. A literature search was performed to include secondary care FWS guidelines of high-income countries, composed by national or regional pediatric or emergency care associations, available in English or Dutch.
Ten guidelines of five high-income countries were included, with varying age ranges of children with FWS. In children younger than one month with FWS, the majority of the guidelines recommended laboratory testing, blood and urine culturing and antibiotic treatment irrespective of the clinical condition of the patient. Recommendations for blood culture and antibiotic treatment varied for children aged 1-3 months. In children aged above three months, urine culture recommendations were inconsistent, while all guidelines consistently recommended cerebral spinal fluid testing and antibiotic treatment exclusively for children with a high risk of serious infection.
We found these guidelines broadly consistent, especially for children with FWS younger than one month. Guideline variation was seen most in the targeted age ranges and in recommendations for children aged 1-3 months and above three months of age. The findings of the current study can assist in harmonizing guideline development and future research for the management of children with FWS.
儿童不明原因发热（FWS）具有诊断挑战性。为了区分自限性感染和严重感染，已制定了多项指南以帮助医生管理 FWS。目前，尚未对现有的 FWS 指南进行比较。
本综述性比较研究描述了指南在定义、诊断和治疗建议方面的一致性和差异。我们进行了文献检索，纳入了来自高收入国家的二级保健 FWS 指南，这些指南由国家或地区儿科或急救护理协会制定，以英文或荷兰文提供。
纳入了来自五个高收入国家的 10 项指南，涵盖的儿童 FWS 年龄范围不同。对于年龄小于 1 个月的发热儿童，大多数指南建议进行实验室检查、血和尿培养以及抗生素治疗，无论患者的临床状况如何。对于 1-3 个月龄的儿童，血培养和抗生素治疗的建议有所不同。对于 3 个月以上的儿童，尿培养建议不一致，而所有指南均一致建议对有严重感染高风险的儿童进行腰椎穿刺检查和抗生素治疗。
我们发现这些指南基本一致，尤其是针对年龄小于 1 个月的发热儿童。指南的差异主要见于目标年龄范围以及 1-3 个月和 3 个月以上儿童的建议。本研究的结果有助于协调指南制定和未来管理发热儿童的研究。
