Characteristics and management of febrile young children seen in a university family practice.

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.