SAQ 194 – Paediatrics – fever without a source
Model Answer
Question 1. fever without a source.
a. Bag urine disadvantages
- Urinalysis has low sensitivity and specificity.
- A positive result may occur in febrile infants without UTI and should not alone prompt treatment.
- Culture has a high contamination and false-positive rate.
- Collection may be delayed while waiting for the child to void.
b. White-cell count
- A normal count does not exclude bacteraemia.
- WCC below 4,000 may indicate severe illness or underlying disease.
- WCC above 15,000 increases the likelihood of bacteraemia; above 20,000 is highly specific.
- Bands above 10% increase the likelihood of serious bacterial infection.
- Lymphocytosis or lymphocytopaenia may support viral infection.
c. Blood cultures
| Pros | Cons |
|---|---|
| Gold standard for bacteraemia and septicaemia. | Invasive and painful. |
| Allows directed antibiotic therapy. | Delayed result does not guide immediate empiric ED treatment. |
| May be the only confirmatory test for occult bacteraemia. | False negatives occur with insufficient samples and false positives with contaminants. |
d. Safe discharge criteria
- Child appears well.
- Observations are acceptable with no oxygen requirement.
- No significant comorbidity, prematurity, or congenital disease.
- Fully immunised.
- Hydration and oral intake are satisfactory.
- Carers are coping and have appropriate support.
- A clear follow-up plan within 24 hours is accepted and understood.
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