TY - JOUR
T1 - Outcomes of children presenting to the emergency department with fever and bulging fontanelle
AU - Shahada, Jiriys
AU - Tavor, Oren
AU - Segev, Or
AU - Rimon, Ayelet
AU - Scolnik, Dennis
AU - Glatstein, Miguel
N1 - Publisher Copyright:
© 2022
PY - 2022/7
Y1 - 2022/7
N2 - Background: In infants aged 3-18 months presenting with a bulging fontanelle and fever it is often necessary to exclude central nervous system infection by performing a lumbar puncture. Several studies have shown that well-appearing infants with normal clinical, laboratory and imaging studies have a benign (non-bacterial) disease. At our institution, we often observe such infants and withhold lumbar puncture. Objective: To determine the clinical characteristics and outcomes of well-appearing, febrile infants with a bulging fontanelle, whether they did or did not undergo lumbar puncture. Design: A retrospective chart review of the medical records of all febrile infants with a bulging fontanelle seen between March 2018 and March 2020 at Dana Children's Hospital. The following data were extracted: age of the patient, gender, previous medical history, general appearance, vomiting, appetite, fever, blood test results and CSF results (when taken), final diagnosis, disposition status, and whether or not the patient returned to our ER. Stats: Descriptive statistics were used to describe the study population. Results: The study group included 40 children, 22 males, and 18 females. Their age ranged from 3 to 13 months. Only 8 of the patients in the study group were admitted and 32 were discharged. Only 13 (32.5%) had an LP performed, three of which had elevated levels of WBC in the CSF, two of them had a positive culture. None of the patients who were discharged returned to the ED. Conclusions: Our study, combined with previous works, supports the assumption that management of well-appearing infants with normal medical history who present with fever and bulging fontanelle could be done without a lumbar puncture. Larger and prospective studies are needed to support this observation.
AB - Background: In infants aged 3-18 months presenting with a bulging fontanelle and fever it is often necessary to exclude central nervous system infection by performing a lumbar puncture. Several studies have shown that well-appearing infants with normal clinical, laboratory and imaging studies have a benign (non-bacterial) disease. At our institution, we often observe such infants and withhold lumbar puncture. Objective: To determine the clinical characteristics and outcomes of well-appearing, febrile infants with a bulging fontanelle, whether they did or did not undergo lumbar puncture. Design: A retrospective chart review of the medical records of all febrile infants with a bulging fontanelle seen between March 2018 and March 2020 at Dana Children's Hospital. The following data were extracted: age of the patient, gender, previous medical history, general appearance, vomiting, appetite, fever, blood test results and CSF results (when taken), final diagnosis, disposition status, and whether or not the patient returned to our ER. Stats: Descriptive statistics were used to describe the study population. Results: The study group included 40 children, 22 males, and 18 females. Their age ranged from 3 to 13 months. Only 8 of the patients in the study group were admitted and 32 were discharged. Only 13 (32.5%) had an LP performed, three of which had elevated levels of WBC in the CSF, two of them had a positive culture. None of the patients who were discharged returned to the ED. Conclusions: Our study, combined with previous works, supports the assumption that management of well-appearing infants with normal medical history who present with fever and bulging fontanelle could be done without a lumbar puncture. Larger and prospective studies are needed to support this observation.
KW - Bulging fontanelle
KW - Cerebrospinal fluid
KW - Lumbar puncture
UR - http://www.scopus.com/inward/record.url?scp=85130385365&partnerID=8YFLogxK
U2 - 10.1016/j.ajem.2022.04.011
DO - 10.1016/j.ajem.2022.04.011
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C2 - 35588655
AN - SCOPUS:85130385365
SN - 0735-6757
VL - 57
SP - 153
EP - 155
JO - American Journal of Emergency Medicine
JF - American Journal of Emergency Medicine
ER -