Identify febrile infants aged 28 – 89 days old who are lower risk for serious bacterial infection
The Boston criteria are a list of historical, examination, and laboratory features that if all are present are reassuring to clinicians treating febrile infants aged 28-89. Specifically, they stratify infants into low or high-risk categories for presence of serious bacterial infection (SBI), and propose discharge, empiric antibiotics, and close follow-up for all low-risk children.
The Boston study (Baskin et al. 1991) studied 503 febrile infants aged 28-89 days old presenting to the emergency department for assessment. To even enter the study criteria, patients needed to satisfy all of the low-risk features now deemed “the Boston criteria” and any exception to these variables resulted in exclusion from the study. Of the 503 infants who satisfied all of the reassuring criteria, follow-up cultures identified 27 infants (5.4%) had SBI (9 with bacteremia, 8 UTI without bacteremia, and 10 bacterial gastroenteritis without bacteremia). All 503 infants with reassuring criteria were discharged with a single-dose of ceftriaxone and all children were followed up within 24 hours in the community.
Therefore, in this study when febrile infants age 28-89 days satisfied these criteria and were deemed low-risk and discharged, there remained a 5.4% incidence of SBI. Author goals were to reduce need for hospitalization in low-risk infants and this was successful in this study as with sufficient follow-up very few infants required admission. This study supports the use of the Boston criteria for identifying infants at low-risk for SBI and recommends that these patients can be safely discharged with one dose of empiric ceftriaxone and close follow up in 24 hours.
Other similar criteria often employed for febrile infants includes the Philadelphia criteria [QxMD link to “Philadelphia Criteria”] and the Rochester Criteria [QxMD link to the “Rochester Criteria”].
A score is assigned by the following variables.
No confounding factors requiring admission including:
All investigation parameters reassuring, including:
Results (either):
All reassuring findings are present (show if yes to all questions)
Non-reassuring findings are present (show if no to any one question)
Baskin MN, O'Rourke EJ, Fleisher GR.
The Boston criteria are a list of historical, examination, and laboratory features that if all are present are reassuring to clinicians treating febrile infants aged 28-89. Specifically, they stratify infants into low or high-risk categories for presence of serious bacterial infection (SBI), and propose discharge, empiric antibiotics, and close follow-up for all low-risk children.
The Boston study (Baskin et al. 1991) studied 503 febrile infants aged 28-89 days old presenting to the emergency department for assessment. To even enter the study criteria, patients needed to satisfy all of the low-risk features now deemed “the Boston criteria” and any exception to these variables resulted in exclusion from the study. Of the 503 infants who satisfied all of the reassuring criteria, follow-up cultures identified 27 infants (5.4%) had SBI (9 with bacteremia, 8 UTI without bacteremia, and 10 bacterial gastroenteritis without bacteremia). All 503 infants with reassuring criteria were discharged with a single-dose of ceftriaxone and all children were followed up within 24 hours in the community.
Therefore, in this study when febrile infants age 28-89 days satisfied these criteria and were deemed low-risk and discharged, there remained a 5.4% incidence of SBI. Author goals were to reduce need for hospitalization in low-risk infants and this was successful in this study as with sufficient follow-up very few infants required admission. This study supports the use of the Boston criteria for identifying infants at low-risk for SBI and recommends that these patients can be safely discharged with one dose of empiric ceftriaxone and close follow up in 24 hours.
Other similar criteria often employed for febrile infants includes the Philadelphia criteria [QxMD link to “Philadelphia Criteria”] and the Rochester Criteria [QxMD link to the “Rochester Criteria”].
A score is assigned by the following variables.
No confounding factors requiring admission including:
All investigation parameters reassuring, including:
Results (either):
All reassuring findings are present (show if yes to all questions)
Non-reassuring findings are present (show if no to any one question)
Baskin MN, O'Rourke EJ, Fleisher GR.
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