Step-by-Step Febrile Infant

The Step-by-Step Approach is an evaluation scheme based upon clinical factors and lab testing which allows clinicians, typically in the Peds ED, to decide which young (≤ 90 days old) febrile infants are at high, intermediate, and low risk of invasive bacterial infection (bacteremia, sepsis, meningitis). Risk assessment allows a clinician to choose less intensive, less invasive management of some young febrile infants depending on local standards, local resources, and particulars of the clinical case. The app is adapted from the validation study by Gomez, Mintegi, and colleagues of July, 2016, with their kind permission. The app is intended for use by health care professionals only, not by the lay public, not by parents.

The app addresses such common questions as: • what are the five steps in the Step-by-Step approach? • what is the diagnostic accuracy of Step-by-Step? • which special populations warrant additional attention? • what are the cutoff levels for procalcitonin, absolute neutrophil count, c-reactive protein? • how does Step-by-Step compare to Rochester criteria (older scheme which also tries to avoid LP)? • aside from invasive bacterial infections, how does Step-by-Step do assessing for other serious bacterial infections?

This app is written and intended for practicing clinicians like Peds ED physicians, pediatricians, and family physicians. The extra educational emphasis is provided for resident physician and medical students to learn as well.

As an educator and clinician, I am interested in feedback and I would be grateful for guidance on improving the tool.