Fever without a source in children: international comparison of guidelines
World J Pediatr · 2022 · Netherlands
Source and licence
- Authors
- Sanne Graaf, Maya Wietske Keuning, Dasja Pajkrt et al.
- Title
- Fever without a source in children: international comparison of guidelines
- Journal
- World Journal of Pediatrics, 2022
- Licence
- CC BY 4.0
- Changes
- Verbatim excerpts; formatting adapted
Full text retrieved 2026-10-27 from Europe PMC · PMC9928815
Licence statement of the original publication
Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.
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Abstract
Background: Fever without a source (FWS) in children poses a diagnostic challenge. To distinguish a self-limiting infection from a serious infection, multiple guidelines have been developed to aid physicians in the management of FWS. Currently, there is no comparison of existing FWS guidelines.
Methods: This comparative review describes consistencies and differences in guideline definitions and diagnostic and therapeutic recommendations. A literature search was performed to include secondary care FWS guidelines of high-income countries, composed by national or regional pediatric or emergency care associations, available in English or Dutch.
Results: Ten guidelines of five high-income countries were included, with varying age ranges of children with FWS. In children younger than one month with FWS, the majority of the guidelines recommended laboratory testing, blood and urine culturing and antibiotic treatment irrespective of the clinical condition of the patient. Recommendations for blood culture and antibiotic treatment varied for children aged 1–3 months. In children aged above three months, urine culture recommendations were inconsistent, while all guidelines consistently recommended cerebral spinal fluid testing and antibiotic treatment exclusively for children with a high risk of serious infection.
Conclusions: We found these guidelines broadly consistent, especially for children with FWS younger than one month. Guideline variation was seen most in the targeted age ranges and in recommendations for children aged 1–3 months and above three months of age. The findings of the current study can assist in harmonizing guideline development and future research for the management of children with FWS.
Supplementary Information: The online version contains supplementary material available at 10.1007/s12519-022-00611-8.
Contents of the original publication
The section headings of the original.
- Introduction
- Methods
- Study design
- Outcome parameters
- Results
- Guideline definitions
- Diagnostic guideline recommendations
- Therapeutic guideline recommendations
- Discussion
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