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freedman sb, al-harthy n, thull-freedman j. the crying infant: diagnostic testing and frequency of serious underlying disease. pediatrics. 2009;123(3):841-848. doi:10.1542/peds.2008-0113

Answer :

Finding out what percentage of kids treated in an emergency room for weeping have a serious underlying reason is the goal.

  • The individual contributions of the history, physical examination, and laboratory tests in making a diagnosis were secondary outcomes.

Patients and methods:

  • We reviewed all afebrile patients under one years of age who had a major complaint of weeping, irritability, screaming, colic, or fussiness retrospectively.
  • The use of a priori established criteria allowed for the identification of all kids who had a serious underlying illness.
  • A review of the records was done to see if information from the child's history, physical exam, or investigation helped to establish the diagnosis.

Results:

  • 237 patients, or 0.6% of all visits, met the enrollment criteria.
  • The most frequent underlying etiology in 12 (5.1%) of the children was urinary tract infection (n = 3).
  • Only on a second visit were two (16.7%) of the critical diagnoses made.
  • 81 (14.1%) of the 574 tests that were conducted were positive.
  • Only 8 (1.4%) diagnoses, however, were made based on a successful inquiry.
  • In 66.3% of cases, the history and/or physical examination pointed to an etiology.
  • Serious etiologies were connected with unwell look.
  • Investigations without a suggestive clinical picture only helped with the diagnosis in 2 (0.8%) of the youngsters.
  • Both of these infants, who were around 4 months old, experienced urethritis.
  • Urine culture results that were performed on infants under one month old were 10% positive.
  • Rarely performed procedures included rectal examination with occult blood tests and ocular fluorescein staining.
  • In each instance, the results were negative.
  • 60% of caregivers successfully performed follow-up, and there were no missed diagnoses.

Conclusions:

  • The history and physical examination continue to be the foundation for evaluating a crying newborn and should guide the choice of investigations.
  • Infants who are afebrile in their first few months of life should have their urine examined.
  • Clinical findings should serve as the foundation for additional investigations.

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