TY - JOUR
T1 - Early postoperative fever workup in children
T2 - utilization and utility
AU - Corkum, Kristine S.
AU - Hunter, Catherine J.
AU - Grabowski, Julia E.
AU - Lautz, Timothy B.
PY - 2018/7
Y1 - 2018/7
N2 - Background: Early postoperative fever is common. Adult data indicate that workup is unnecessary in the early postoperative period, but comparable data in children is limited. The objectives are to determine the incidence of fever and the utilization and yield of tests ordered in children. Methods: Single-institution, retrospective analysis of surgical patients undergoing an elective inpatient/observational surgery between 2011 and 2015 was performed. Early fever was defined > 38.0 °C within two days post-procedure. Encounters were queried for all blood cultures (BC), urinalysis (UA), urine cultures (UC), chest radiographs (CXR), and respiratory viral panels (RVP) obtained. Results: We identified 6943 patients, of whom 30.6% developed fever. UA was positive in 19.8% of patients tested. UC was positive in 15.7% of patients and 92.0% had a urinary catheter during surgery. BC was positive in 0.69% of patients, all with a central venous catheter. CXRs were considered infectious in 3.0% of patients tested. Patients with PICU stay and/or fever ≥ 38.9 °C were more likely to undergo BC and UC, but no more likely to have a positive result compared those without PICU stay and/or fever < 38.9°. Conclusion: Early postoperative fever is common in pediatric surgical populations and rarely associated with an infectious source. Workup should be applied selectively. Level of evidence: Level IV.
AB - Background: Early postoperative fever is common. Adult data indicate that workup is unnecessary in the early postoperative period, but comparable data in children is limited. The objectives are to determine the incidence of fever and the utilization and yield of tests ordered in children. Methods: Single-institution, retrospective analysis of surgical patients undergoing an elective inpatient/observational surgery between 2011 and 2015 was performed. Early fever was defined > 38.0 °C within two days post-procedure. Encounters were queried for all blood cultures (BC), urinalysis (UA), urine cultures (UC), chest radiographs (CXR), and respiratory viral panels (RVP) obtained. Results: We identified 6943 patients, of whom 30.6% developed fever. UA was positive in 19.8% of patients tested. UC was positive in 15.7% of patients and 92.0% had a urinary catheter during surgery. BC was positive in 0.69% of patients, all with a central venous catheter. CXRs were considered infectious in 3.0% of patients tested. Patients with PICU stay and/or fever ≥ 38.9 °C were more likely to undergo BC and UC, but no more likely to have a positive result compared those without PICU stay and/or fever < 38.9°. Conclusion: Early postoperative fever is common in pediatric surgical populations and rarely associated with an infectious source. Workup should be applied selectively. Level of evidence: Level IV.
KW - Children
KW - Fever
KW - Infection
KW - Workup
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U2 - 10.1016/j.jpedsurg.2017.06.019
DO - 10.1016/j.jpedsurg.2017.06.019
M3 - Article
C2 - 28693850
AN - SCOPUS:85021853805
VL - 53
SP - 1295
EP - 1300
JO - Journal of Pediatric Surgery
JF - Journal of Pediatric Surgery
SN - 0022-3468
IS - 7
ER -