The Kern Fever in the Emergency Department Study (Kern FEDS): Clinical appearance, serious bacterial illness, and the meaning of uncertainty.

Abstract

Background: Emergency department (ED) fever management algorithms require the clinician to categorize febrile children as 'ill' or 'not ill' appearing when determining the risk for serious bacterial illness (SBI). This study describes a natural experiment where an ED pediatric chart allowed clinicians a third option, 'unsure'. Hypotheses: We hypothesized (1) that chart prompts would improve documentation of clinical appearance, and (2) that exam findings and prevalence of serious bacterial illness in infants categorized as 'unsure' would be intermediate between those who were ill and not ill appearing. AcknowledgmentsThe authors wish to acknowledge the assistance of Nathan Kuppermann MD and Stephen J Rothenberg with this manuscript.