Could this mean we no longer have to treat them all?
Which group did the guideline consider?
• Term babies 8-60 days old with fever
• Exclusions: complex conditions, recent imms
What factors did the working group include?
• Blood results, urine culture, CSF culture
This is a guideline based on the Working Group's findings.
What were the key findings?
• WCC isn't that great a marker
• Procalcitonin is best
• If you can't use procalcitonin then use CRP + neutrophils + temp status
• Don't forget about HSV
At the moment we will still be cautious, but tailored guidelines are in the future.
Paper #2: Should we treat every child with a non-blanching rash (NBR) as meningococcal disease?
Families know the 'glass test'.
But in our practice we see so many well children with NBR.
• <18 years presenting to UK EDs over 16 months (1344 children)
• Inclusion: fever, new NBR, features of mening disease
• Exclusions: haem conditions, HSP
They looked at how good 8 UK guidelines were in identifying those with meningococcal disease.
What did they find?
• 1% had meningococcal disease
• 2% had bacterial infection
All 8 guidelines had 100% sensitivity - no patients were missed.
But NICE had 0% specificity - it treated EVERYONE.
The best was (of course) Barts Health:
•100% sensitivity
• 36% specificity
Paper #3: For displaced forearm fractures, should we call Ortho or do it ourselves?
• 3m-18y presenting to RCH Melbourne over 5 years
• Inclusions; periorbital oedema or erythema
• Exclusions: allergic reaction or bites
What did they find?
• 216 patients
• 5 (2%) had orbital cellulitis
• 65% overall were treated with IV antibiotics
We tend to be cautious in treating periorbital cellulitis.
All 5 had fever 4/5 had vomiting/headache
The actual rates of orbital cellulitis are low (2%).
• If your patient has vomiting or headache then refer to Ophthal
• Use the Asset score to direct IV v oral management
TL;DR- 5 PEM papers to change your practice
• Do all febrile neonates need treatment?
• Should we treat everyone with a non-blanching rash?
• Are we good at forearm fracture reduction?
• Does ⬇️ sodium cause cerebral oedema in DKA?
• Do we over-treat periorbital cellulitis?
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