What is the appropriate workup for a 12-month-old patient presenting to the Emergency Room (ER) with hyperpyrexia (fever of 40.8 degrees Celsius) and no other symptoms?

From the Guidelines

For a 12-month-old patient presenting with a high fever of 40.8°C without other symptoms, a thorough workup including a complete blood count, blood culture, urinalysis with culture, and chest X-ray is essential to identify potential sources of infection, as recommended by the American College of Emergency Physicians 1. The patient's age and high fever increase the risk for serious bacterial infections, such as urinary tract infections, bacteremia, and meningitis, which can have severe consequences if left untreated 1.

• Initial management should include acetaminophen (10-15 mg/kg every 4-6 hours) or ibuprofen (5-10 mg/kg every 6-8 hours) to reduce fever.
• A physical examination should focus on identifying potential sources of infection, including the ears, throat, lungs, abdomen, and skin.
• Viral testing may be appropriate depending on the season and presentation.
• A lumbar puncture may be considered if there are any signs of meningitis or if the child appears toxic.
• Close monitoring of vital signs and hydration status is crucial.
• Parents should be educated about fever management at home and warning signs that would necessitate return to medical care, such as difficulty breathing, persistent vomiting, or severe headache. The most recent and highest quality studies suggest that urinary tract infections are a common cause of fever in infants and young children, and that prompt diagnosis and treatment are essential to prevent long-term complications 1.
• The use of a combination of diagnostic tests, including urinalysis and culture, can help identify urinary tract infections and guide treatment.
• Empiric antibiotics may be warranted if laboratory results suggest bacterial infection or if the child appears ill, as the risk of serious bacterial infections is high in this age group 1.

From the Research

Evaluation of a 12-Month-Old Patient with Fever

• The patient presents with a fever of 40.8 Celsius, which is a common reason for children and infants to be brought to emergency departments 2.
• The management of fever in children is guided by the patient's age, immunization status, and immune status, as well as the results of a careful physical examination and appropriate laboratory tests and radiographic views 2.

Laboratory Tests and Radiographic Views

• For febrile infants aged 0 to 56 days, clinical practice guidelines can expedite care and standardize management, reducing the need for laboratory testing, antibiotic administration, and hospital admission 3.
• However, for a 12-month-old patient, the approach may differ, and laboratory tests such as complete blood count, blood culture, and urine culture may be considered.
• Lumbar puncture may be considered in certain cases, such as when meningitis is suspected, but its necessity depends on the patient's clinical presentation and risk factors 4, 5.

Clinical Presentation and Risk Factors

• The patient's clinical presentation, including the presence of fever, neck stiffness, and altered mental status, can help guide the evaluation and management of the patient 6.
• The absence of these findings can effectively eliminate meningitis, but the presence of fever and headache may warrant further evaluation, including lumbar puncture 6.
• The patient's age, immunization status, and immune status should also be considered when evaluating the risk of meningitis and other serious infections 2, 3.