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    Rochester Criteria for Febrile Infants

    Determines whether febrile infants are low risk for serious bacterial infection.

    INSTRUCTIONS

    Use in febrile infants ≤60 days of age (rectal temp ≥38°C or 100.4°F).

    Diagnostic Result

    Not low risk

    Perform further testing: CBC, UA, blood/urine cultures, and likely CSF testing.
    Copy Results
    Dr. Julie Jaskiewicz
    Dr. Julie Jaskiewicz
    About the creator

    Julie Jaskiewicz, MD, is a pediatrician affiliated with HealthSource of Ohio, the Cincinnati Children’s Hospital Medical Center, and Mercy Health Anderson Hospital. She is also a fellow of the American Academy of Pediatrics. Dr. Jaskiewicz's research interests include evaluation and management of febrile infants as well as impact of night shift work on pediatric residents.

    Are you Dr. Julie Jaskiewicz? Send us a message to review your photo and bio, and find out how to submit Creator Insights!
    MDCalc loves calculator creators – researchers who, through intelligent and often complex methods, discover tools that describe scientific facts that can then be applied in practice. These are real scientific discoveries about the nature of the human body, which can be invaluable to physicians taking care of patients.
    Dr. Ron Dagan
    Dr. Ron Dagan
    From the creator

    Why did you develop the Rochester Criteria? Was there a particular clinical experience or patient encounter that inspired you to create this tool for clinicians?

    Prior to the development of the Rochester Criteria, the consensus was that there was no way to predict which child under 3 months of age will have serious bacterial infection (SBI). Too many children that obviously did not have much risk to have SBI were hospitalized, submitted to sepsis workup, and treated with antibiotics for 2-3 days at least. My thought was that instead of looking for who has SBI, we needed to look at those who are very likely NOT to have SBI.

    I have used my clinical experience from my residency in Israel to set a list of criteria that would suggest no SBI and tested them first in Rochester (during my fellowship) and then submitted them for validation later in Israel. These criteria were proved to be able to rule out more than 2/3 of the "suspected" children under 3 months of age, and thus only ~1/3 needed to be subjected to sepsis workup.

    What pearls, pitfalls and/or tips do you have for users of the Rochester Criteria? Do you know of cases when it has been applied, interpreted, or used inappropriately?

    1. Remember that part of these criteria is the absence of previous history that suggests SBI (previously healthy!).
    2. Remember that any real sick looking baby (i.e., toxic) should be treated anyhow.
    3. Remember that very low risk is still not 100% proof! The group of neonates under 2-3 weeks was the minority in these studies, so be even more careful with this group before you decide they are low risk.
    4. Remember to follow all those who are not treated very carefully!

    What recommendations do you have for doctors once they have applied the Rochester Criteria? Are there any adjustments or updates you would make to the score based on new data or practice changes?

    Just remember that infants <2-3 months may show a dynamic disease, so follow up very carefully.

    How do you use the Rochester Criteria in your own clinical practice? Can you give an example of a scenario in which you use it?

    In our pediatric emergency room at the Soroka University Medical Center in Beer-Sheva, Israel, the Rochester criteria are the gold standard guidelines for suspected sepsis or febrile children <2-3 months. However, we always warn that in doubt, treat. Low risk infants can be sent home if there is no other reason for hospitalization (e.g. dehydration, hypoxemia).

    About the creator

    Ron Dagan, MD, is a distinguished professor of pediatrics and infectious diseases at the Ben-Gurion University of the Negev in Beer-Sheva, Israel. He also created the pediatric infectious disease unit at the Soroka University Medical Center, where he was director until 2014. Dr. Dagan is an active researcher, primarily focusing on new conjugate vaccines, epidemiology of vaccine-preventable diseases, and other infectious disease topics.

    Are you Dr. Ron Dagan? Send us a message to review your photo and bio, and find out how to submit Creator Insights!
    MDCalc loves calculator creators – researchers who, through intelligent and often complex methods, discover tools that describe scientific facts that can then be applied in practice. These are real scientific discoveries about the nature of the human body, which can be invaluable to physicians taking care of patients.
    Content Contributors
    • Laura Mercurio, MD
    About the Creator
    Dr. Julie Jaskiewicz
    Dr. Julie Jaskiewicz
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