Fever Clinical Pathway — All Settings

Host Compromise

Definition	Patients < 56 days of age Recent surgery (breach of skin barrier) Presence of internal device/hardware Surgical instrumentation/patches; central lines, shunts Primary immunodeficiency Secondary/acquired immunodeficiency HIV/AIDS Long-term corticosteroids — daily or alternate day corticosteroids for ≥ 14 days Immunosuppressive agents Neutropenia Malignant neoplasm Stem cell or solid organ transplantation, engineered cell therapy Asplenia or functional asplenia e.g., sickle cell disease Chronic renal disease Disease process with associated immunocompromise: e.g., nephrotic syndrome, 22q heterotaxy, epidermolysis bullosa, other
If “Yes” to Host Compromise	Consider: Additional diagnostic testing based on patient’s risk Need for rapid antibiotic therapy Need for stress dose steroids Consult with subspecialist as indicated Use directed pathways as indicated: Febrile Young Infant Fever Non-oncology Central Venous Catheter Oncology Patient with Fever Sickle Cell Disease with Fever Sepsis, ED, Inpatient, PICU Steroid Stress Dosing VPS Obstruction, Infection

Definition

Patients < 56 days of age
Recent surgery (breach of skin barrier)
Presence of internal device/hardware
- Surgical instrumentation/patches; central lines, shunts
Primary immunodeficiency
Secondary/acquired immunodeficiency
- HIV/AIDS
- Long-term corticosteroids — daily or alternate day corticosteroids for ≥ 14 days
- Immunosuppressive agents
- Neutropenia
- Malignant neoplasm
- Stem cell or solid organ transplantation, engineered cell therapy
- Asplenia or functional asplenia
  - e.g., sickle cell disease
- Chronic renal disease
- Disease process with associated immunocompromise:
  - e.g., nephrotic syndrome, 22q heterotaxy, epidermolysis bullosa, other

If “Yes” to Host Compromise

Consider:
- Additional diagnostic testing based on patient’s risk
- Need for rapid antibiotic therapy
- Need for stress dose steroids
- Consult with subspecialist as indicated

Use directed pathways as indicated:

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The clinical pathways are based upon publicly available medical evidence and/or a consensus of medical practitioners at The Children’s Hospital of Philadelphia (“CHOP”) and are current at the time of publication. These clinical pathways are intended to be a guide for practitioners and may need to be adapted for each specific patient based on the practitioner’s professional judgment, consideration of any unique circumstances, the needs of each patient and their family, and/or the availability of various resources at the health care institution where the patient is located.

Accordingly, these clinical pathways are not intended to constitute medical advice or treatment, or to create a doctor-patient relationship between/among The Children’s Hospital of Philadelphia (“CHOP”), its physicians and the individual patients in question. CHOP does not represent or warrant that the clinical pathways are in every respect accurate or complete, or that one or more of them apply to a particular patient or medical condition. CHOP is not responsible for any errors or omissions in the clinical pathways, or for any outcomes a patient might experience where a clinician consulted one or more such pathways in connection with providing care for that patient.