Commentary on Practice Guidelines

In this issue of Pediatrics, Drs Kramer and Shapiro review the practice guideline published in Pediatrics in July 1993.1 The guideline addressed two patient populations with fever without source (FWS): 1) infants 0 to 90 days of age with a temperature ≥38.0°C, and 2) infants and children 3 to 36 months of age with a temperature ≥39.0°C. The first group was essentially stratified into two populations: 1a) infants <28 days, and 1b) infants 28 to 90 days of age. It was the panel's intention to follow the lead of Dr Keith Powell and his colleagues, and try to reduce the number of tests and unnecessary hospitalizations in young febrile infants by screening with “low-risk” clinical and laboratory criteria. Recent studies support this approach and suggest that the low-risk criteria may be used in younger children as well. Therefore, the definition of group 1a may need to be changed to 0 to 7 days of age.2 Kramer and Shapiro do not comment on the recommendations for young infants but take exception with the recommendations for children 3 to 36 months of age. They “believe that the use of the guideline may do more harm than good” but present no evidence to support their belief. Some of their statements are correct: 1) there is little data to suggest that practicing physicians are …