PEDIATRICS Vol. 85 No. 6 June 1990, pp. 1040-1043
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Failure of Infant Observation Scales in Detecting Serious Illness in Febrile, 4-to 8-Week-Old Infants

M. Douglas Baker MD1, Jeffrey R. Avner MD1, and Louis M. Bell MD1

1 From the Divisions of General Pediatrics (Emergency Medicine) and Infectious Diseases, The Children's Hospital of Philadelphia, and the Department of Pediatrics, University of Pennsylvania School of Medicine, Philadelphia

All infants aged 29 to 56 days with rectal temperatures in excess of 38.2° Cwho presented to the Emergency Department of The Children's Hospital of Philadelphia from July 1987 through July 1988 were studied. Each infant was scored (1 to 5) on each of the six items in the Yale Observation Scale by an Emergency Department attending physician before history and physical examination. Individual scores were then added to yield a total score for each patient. An observation score of 10 or less was indicative of a generally well-appearing child, and a score of 16 or more represented an ill-appearing child. Of 126 infants enrolled, 37 (29%) had serious illness; 12 (9.5%) had culture-proven bacterial disease. Of all infants with an observation score le10 (n = 91), 22% had serious illness, and of all infants with an observation score ge16 (n = 20), only 45% had serious illness. The findings suggest that even in experienced hands, the Yale Observation Scale alone does not provide sufficient data to identify serious illness in febrile, 1-to 2-month-old infants.

Key Words: fever • Infant Observation Scale

Submitted on November 18, 1988
Accepted on June 26, 1989




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