Soman M
J Fam Pract. 1985 Aug;21(2):117-22.
A cohort of 311 children registered with the University of Washington Family Medical Center was retrospectively identified and followed until the age of 2 years. Analysis of all encounters for which a temperature of 37.7 degrees C (100 degrees F) or above was noted revealed 438 such encounters among 189 patients. Only 30 encounters involved patients aged under 3 months, and in 74 percent of the encounters the temperature was below 38.9 degrees C (102 degrees F). The most common diagnoses were otitis media (34 percent), upper respiratory tract infection (19 percent), fever without a source (14 percent), and acute gastroenteritis (7 percent). While antibiotic usage, follow-up, and laboratory utilization all increased with increasing temperature, the latter was unrelated to a child's age. Laboratory evaluation of children considered at high risk for occult illness did not adhere to published guidelines. A more aggressive laboratory approach is recommended for such children, as is follow-up contact. Further studies to evaluate the risk of occult illnesses in febrile children seen in family medicine settings would be helpful in refining and improving management strategies in these settings.
对在华盛顿大学家庭医疗中心登记的311名儿童进行了回顾性识别，并跟踪至2岁。对所有记录体温在37.7摄氏度（100华氏度）及以上的诊疗情况进行分析后发现，189名患者中有438次这样的诊疗情况。只有30次诊疗涉及3个月以下的患者，且在74%的诊疗情况中，体温低于38.9摄氏度（102华氏度）。最常见的诊断是中耳炎（34%）、上呼吸道感染（19%）、不明原因发热（14%）和急性肠胃炎（7%）。虽然抗生素使用、随访和实验室检查的使用都随体温升高而增加，但后者与儿童年龄无关。对被认为有隐匿性疾病高风险的儿童进行的实验室评估并未遵循已发表的指南。建议对这类儿童采取更积极的实验室检查方法，并进行随访。进一步研究以评估在家庭医疗环境中就诊的发热儿童患隐匿性疾病的风险，将有助于完善和改进这些环境中的管理策略。
