Clinical Pathway for Evaluation/Treatment
of Children with Fever
- Related Pathways
- Appendicitis, Inpatient
- Bronchiolitis, ED
- Bronchiolitis, Inpatient
- Cellulitis, Preseptal or Orbital, All Settings
- Cellulitis/Abscess, ED
- Cellulitis/Abscess, Inpatient
- COVID-19 Screening, ED
- COVID-19 Screening, Inpatient
- COVID-19 Screening, Outpatient Specialty and Primary Care
- COVID-19, Acute, All Settings
- Croup, ED
- Croup, Inpatient
- Fever in the Returned Traveler, ED
- Gastroenteritis and Dehydration, ED
- Heart Failure, Suspected, ED, ICU, Inpatient
- Influenza/Flu, ED
- Kawasaki Disease, ED and Inpatient
- Meningitis, Suspected, ED, Inpatient, ICU
- Multisystem Inflammatory Syndrome
(MIS-C), Emergency, ICU and Inpatient - Neck Space Infection, Deep, ED
- Osteomyelitis, ED and Inpatient
- Otitis Media, Acute, All Settings
- Pneumonia, All Settings
- Sepsis, ED, Inpatient, PICU
- Sepsis, CICU
- Septic Arthritis, ED
- Sexually Transmitted Infections
(STI) in Adolescents,
ED, Primary Care - Urinary Tract Infection
(UTI), Febrile, All Settings
Triage
- EPIC Sepsis Screen
- Recent Travel Screen
- Infectious Disease Exposure Screen
- Isolation & Infection Control Considerations
Sepsis Screen
Positive
Positive
Sepsis Huddle
ED, Inpatient and PICU Sepsis Pathway
ED, Inpatient and PICU Sepsis Pathway
FLOC, RN Team Assessment
- History and Physical
- Determine Signs, Symptoms of Suspected/Recognizable Bacterial or Viral Infection
Other Considerations
Age > 56 days – 24 months
- Evaluate UTI risk factors
- Consider occult pneumonia
- Immunizations Status
Age > 24 months
- History & physical-directed evaluation
Treatment
- Supportive Care Only for Most Viral Illnesses
- Consider Influenza Season/Treatment Indications
- Bacterial Infections, Pathogens, and Antibiotics
- CHOP Antibiograms
Disposition
Admission
- Assure adequate hydration
- Appropriate VS
- Fever care, specific discharge instructions
- Have family review Fever Video
- Follow-up recommendations
Posted: October 2018
Revised: December 2020
Authors: K. Cohn, MD, MPH; F. Balamuth, MD, PhD; R. Marchese, MD; F. Henretig MD; J. Gerber MD, PhD; K. Chiotos, MD; L. Bell, MD; A. Grossman, MD; J. Hart, MD; T. Metjian, PharmD; J. Burham, MD; J. Lavelle, MD; C. Jacobstein, MD; A. Vinograd, MD; E. Sanseau, MD
Revised: December 2020
Authors: K. Cohn, MD, MPH; F. Balamuth, MD, PhD; R. Marchese, MD; F. Henretig MD; J. Gerber MD, PhD; K. Chiotos, MD; L. Bell, MD; A. Grossman, MD; J. Hart, MD; T. Metjian, PharmD; J. Burham, MD; J. Lavelle, MD; C. Jacobstein, MD; A. Vinograd, MD; E. Sanseau, MD
Evidence
- Pediatric fever of unknown origin. Pediatr Rev. 2015
- Thermometry in paediatric practice
- Technical report—Diagnosis and management of an initial UTI in febrile infants and young children
- Risk stratification and management of the febrile young child
- Occult pneumococcal bacteremia: a review
- 2017 AHA Kawasaki Disease Guidelines
- Fever in the returning traveler, part II: A methodological approach to initial management
- Clinical practice guideline for the diagnosis and management of acute bacterial sinusitis in children aged 1 to 18 years