Clinical Presentation:

You are called to the ER to evaluate a 60 day old infant with a fever of 102.2. The infant is well appearing, has a negative urinalysis, a procalcitonin of 0.4, an absolute neutrophil count of 9,000/mm, and CRP of 25. Is this infant high, intermediate or low risk for invasive bacterial illness? Should this infant be admitted? Receive antibiotics? What other evaluation should be performed? The Step-by-Step Febrile Infant app can help you with these decisions. Let’s take a look at the medical app in action.

Video Review of the Step-by-Step Febrile Infant app

Few medical conditions create more anxiety for parents and providers than the febrile infant. Fever is one of the top reasons infants are brought to the ER and urgent care centers. The most feared condition is an invasive bacterial illness such as sepsis or meningitis, yet most are suffering from a self-limiting viral illness.

Unfortunately, a 60 day old infant cannot tell you this easily and many are subjected to extensive and unnecessary work-ups that create more anxiety and increase costs from lab tests and hospital admissions. Over the last 20 years, several guidelines have been published using low-risk criteria including the Rochester and Philadelphia Criteria to help providers decide which febrile infants are at highest risk of invasive bacterial illness.

Unfortunately, many of these studies were published in the 1990’s before the availability of the Hib and pneumococcal vaccines. What if there was a better way that could help determine which febrile infants required an extensive work-up while sparing most and not missing any who were truly septic? Drs Gomez, Mintegi, et al. did just that this year with the publication of their step-by-step method of determining risk of invasive bacterial infection in the febrile infant.

Dr Joshua Steinberg comes to the rescue again! He contacted the study authors and was given their permission to develop the step-by-step algorithm into a medical app. For years, I have used Dr Steinberg’s many outstanding medical applications. This past year alone he has released many medical apps that I have reviewed here on iMedicalApps including PneumoVaccinesDepo Calendar, OB Wheels, and Gout Diagnosis. Other useful point of care apps by Dr Steinberg include PreopEval14PFT EvalEFM GuidePE & DVT Dx Tool, and my favorite, Pneumonia Guide.

Evidence based medicine

Step-by-Step Febrile Infant incorporates an evidence-based algorithm that published in the journal, Pediatrics, in 2016. The article compared the Step-by-Step method against the Rochester and Lab-Score methods of risk assessment in 2,185 febrile infants in multiple ED’s in Europe. The Step-by-Step method performed the best with the highest sensitivity and negative predictive value. Furthermore, the study demonstrated that the Step-by-Step method would spare the most infants an invasive workup to rule-out sepsis. The medical app expertly applies this data in an easy to use interface that can be used at the point-of-care.

What providers would benefit from this medical app?

Students, residents, mid-levels, Family Medicine, Pediatric, Emergency Medicine, and any provider who cares for febrile infants.

Disclaimer: The views expressed are those of the author(s) and do not reflect the official policy of the Department of the Army, the Department of Defense or the U.S. Government.

  • Price
    • Free
    • Fantastic evidence-based calculator that will change practice.
    • Well-referenced will hyperlinks to PubMed.
    • Contains easy to follow annotated graphic.
  • Dislikes
    • Medical app is text heavy in some sections.
    • Medical app does not contain much information on the Lab-Score method of risk assessment.
    • Not available for Android.
  • Overall

    Step-by-Step Febrile Infant is another outstanding medical app to Dr Steinberg’s growing collection of point of care apps. This app uses the latest evidence published in 2016 to assess risk of invasive bacterial infection in febrile infants called Step-by-Step. This improved algorithm should change practices everywhere and replace the outdated Rochester Criteria and the inferior Lab-Score method.

  • Overall Score
  • User Interface

    Looks like the other apps by the author meaning it is basic, but easy to use.

  • Multimedia Usage

    Contains links for all references in PubMed and a graphic of the Step-by-Step algorithm.

  • Price

    App is free!

  • Real World Applicability

    A much needed addition to the app store, Step-by-Step Febrile Infant brings cutting edge research on the febrile infant and puts it into the palm of your hand. The app uses the validated Step-by Step approach to assess risk. The only drawback is you still must use your own local standard of care regarding the work-up once you have determined risk.

  • Device Used For Review

    iPhone 6S running iOS 9.3.5

  • Available for DownloadiPhoneiPad