This is Steve Carroll, and you're listening to EM Basic Essential Evidence. Today we'll be talking

about a study that helped us change the way we think about kids who have fever without an obvious source.

This study helped us save a lot of time, money, and resources, and helped us avoid routine blood draws

in little kids in the ED who have a fever but look well.

As always, this podcast doesn't represent the visa opinions of the Department of Defense,

the U.S. Army of the Fort Hood Post Command.

The title of this article is,

prevalence of occult bacteremia in children aged 3 to 36 months,

presenting to the emergency department with fever in the post-numacoccal

conjugate vaccine era. It was published in academic emergency medicine, March 2009, and the first

author is Matthew Wilkinson. I'll post a link to the free full-text article on EMBASIC.org.

First, let's give a little background. It used to be standard

practice that kids three to 36 months, who had a fever without a source, would routinely get

blood cultures drawn. I know that this seems crazy when you consider how we practice today,

because no one is sticking and while appearing one year old for blood cultures anymore, but that was the way things were done before this paper. The theory was that a

certain percentage of kids will have what is called occult bacteremia. These are kids who look

well on the outside, but who are harboring a serious bacterial infection. This was usually

caused by pneumococcus,

but in the mid-90s, a pneumococcal vaccine was introduced

that dramatically reduced the incidence of pneumococcal infections.

This reduction in pneumococcus led to a dramatic decrease in the incidence of occult bacteremia,

so researchers started questioning whether we should

...