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- W2043481632 abstract "We appreciate the opportunity to respond to Dr. Toll's comments on the generalizability of our findings to patients seen in primary care settings.1Teach SJ Fleisher GR The Occult Bacteremia Study Group Efficacy of an observation scale in detecting bacteremia in febrile children three to thirty-six months of age, treated as outpatients.J PEDIATR. 1995; 126: 877-881Abstract Full Text Full Text PDF PubMed Scopus (62) Google Scholar We have acknowledged in our article that our population was limited to patients seen in emergency departments at tertiary care centers, but we believe that it was an otherwise unselected sample of the full racial and socioeconomic spectrum, similar to that seen in private offices everywhere. All children were seen and enrolled by attending physicians, some with 20 years of pediatric experience. Residents did not enroll patients. The implication of Dr. Toll's letter is that a pediatrician in a primary care setting may be at an advantage in evaluating a febrile child's risk of bacteremia because of his or her familiarity with the child. We believe that there are limitations to any physician's ability in any clinical setting to discriminate patients with and without bacteremia. Our data demonstrate that patients with bacteremia had few discernible signs of invasive infection as judged by a group of experienced physicians. Studies by others in private office settings have demonstrated that occult bacteremia often goes undetected and leads to focal sequelae.2Baron MA Fink HD Bacteremia in private pediatric practice.Pediatrics. 1980; 66: 171-175PubMed Google Scholar, 3Baron MA Fink HD Cicchetti DV Blood cultures in private pediatric practice: an eleven-year experience.Pediatr Infect Dis J. 1989; 8: 2-7Crossref PubMed Scopus (20) Google Scholar, 4Dershewitz RA Wigder HN Wigder CM Nadelman DH A comparative study of the prevalence, outcome, and prediction of bacteremia in children.J PEDIATR. 1983; 103: 352-358Abstract Full Text PDF PubMed Scopus (59) Google Scholar In particular, Dershewitz et al.4Dershewitz RA Wigder HN Wigder CM Nadelman DH A comparative study of the prevalence, outcome, and prediction of bacteremia in children.J PEDIATR. 1983; 103: 352-358Abstract Full Text PDF PubMed Scopus (59) Google Scholar reported that pediatricians in their offices were not significantly better in detecting bacteremia than were physicians in an urban, tertiary care emergency department. Further, pediatricians in their offices were not able to evaluate patients known to their practice with any more ease than those coming for a first visit. We did not intend to question the skills of physicians in any particular milieu, but to point out that bacteremia starts subclinically with a very small number of circulating organisms. It must reach a certain magnitude before becoming clinically apparent.5Bell LM Alpert G Campos JM Plotkin SA Routine quantitative blood cultures in children with Haemophilus influenzae or Streptococcus pneumoniae bacteremia.Pediatrics. 1985; 76: 901-904PubMed Google Scholar, 6Sullivan TD LaScolea LJ Neter E Relationship between the magnitude of bacteremia in children and the clinical disease.Pediatrics. 1982; 69: 699-702PubMed Google Scholar In coming to our conclusions, we analyzed data collected during 4 years from more than 6000 patients. We believe that our conclusions stem from a thoughtful consideration of the existing information, but we would always be willing to reexamine the issue in the light of other data with which we are unfamiliar. 9/35/68239" @default.
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- W2043481632 date "1995-12-01" @default.
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- W2043481632 title "Reply to: Clinical recognition of occult bacteremia" @default.
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- W2043481632 doi "https://doi.org/10.1016/s0022-3476(95)70052-8" @default.
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