Evaluation of a clinical score to differentiate between bacterial and non bacterial etiology in the first 4 days of a febrile illness in children

There is a high prevalence of antimicrobial resistance among the bacterial isolates of blood stream infections among Indian children. Misuse of antibiotics is an important factor for accelerating the resistance mechanisms among bacteria. Presently physicians rely on their clinical skills to decide on prescribing an antibiotic and these skills vary from individual to individual. There is a clear need for a clinical scoring tool which can be conveniently utilized in the first visit of a child presenting with an acute febrile illness and which can most accurately rule out bacterial infections requiring antibiotics in the first four days of illness. For a better acceptance, this tool needs to be reliable, inexpensive, non invasive and simple for use in a resource limited setting

The data obtained regarding the characteristics of fever will be converted into a score. This will be used to put down a provisional diagnosis of bacterial infection or no bacterial infection. Bacterial infection is assigned lower points and higher points for other causes. Points are assigned as per the importance of relevance for differentiation. Inter-febrile period is the most important point of difference and hence assigned 3 points in favour of non-bacterial and 0 point for bacterial infection. 

An independent observer will record the observations/data required to use the clinical tool without interfering with the patient management by the primary pediatrician. Therefore there are no indirect or direct benefit or risk to the patients during the study.