Management of the febrile child: a survey of pediatric and emergency medicine residency directors.

We conducted a survey to determine whether there is uniformity in the training of residents regarding the management of febrile children. One hundred forty-three (62%) of 231 pediatric and 39 (53%) of the 73 emergency medicine residency directors responded. There was no uniformity in the definition of a fever. Ninety-nine percent of the pediatric and 82% of the emergency medicine residency directors teach that all febrile infants less than 4 weeks of age should be hospitalized (P less than 0.0001). Forty-six percent of residency directors teach that a lumbar puncture should be performed for all children less than 12 months of age with their first febrile convulsion. Thirty percent of pediatric and 62% of emergency medicine residency directors teach that a blood culture should be obtained from a child with fever without source who is younger than 24 months of age (P less than 0.0005). Nonspecific tests are taught to be used to determine which febrile child should have a blood culture as follows: white blood cell count, 50%; differential, 20%; erythrocyte sedimentation rate, 13%; and C-reactive protein, 2%. There was little uniformity of teaching regarding the approach to the febrile child and there were significant differences in training by specialty.