BMC Public Health Research article Self-reported pediatricians' management of the well-appearing young child with fever without a source: first survey in an European country in the anti-pneumococcal vaccine era Elena Chiappini1, Luisa Galli1, Francesca Bonsignori1, Elisabetta Venturini1, Nicola Principi2 and Maurizio de Martino*1 BioMed Central Open Access Address: 1Department of Pediatrics, University of Florence, Florence, Italy and 2Department of Maternal and Pediatric Sciences, University of Milan, Fondazione IRCCS Ospedale Maggiore Policlinico, Mangiagalli e Regina Elena, Milan, Italy Email: Elena Chiappini - echiappini@unifi.it; Luisa Galli - luisa.galli@unifi.it; Francesca Bonsignori - francescabonsignori@yahoo.it; Elisabetta Venturini - elisabetta-venturini@virgilio.it; Nicola Principi - nicola.principi@unimi.it; Maurizio de Martino* - maurizio.demartino@unifi.it * Corresponding author Published: 19 August 2009 BMC Public Health 2009, 9:300 doi:10.1186/1471-2458-9-300 This article is available from: http://www.biomedcentral.com/1471-2458/9/300 Received: 28 October 2008 Accepted: 19 August 2009 © 2009 Chiappini et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Abstract Background: Recent studies suggest a substantially reduced risk of invasive bacterial infection in children vaccinated with heptavalent pneumococcal conjugate vaccine (PCV). To investigate whether the introduction of PCV might affect clinical decision making, we conducted a cross- sectional survey aimed at Italian Pediatric physicians. Results: The study included 348 (46.5%) primary care pediatricians; 251 (36.4%) hospital pediatricians, and 139 (20.1%) pediatric residents. In an hypothetical scenario, a well-appearing 12- month-old child with fever without source would be sent home with no therapy by 60.7% (419/ 690) of physicians if the child was not vaccinated with PCV. The proportion increased to 74.2% (512/690) if the child had received PCV (P < 0.0001). Also, physicians would obtain blood tests less frequently in the vaccinated than in unvaccinated children (139/690 [20.1%] vs. 205/690 [29.7%]; P < 0.0001), and started empiric antibiotic therapy less frequently (3.0% vs. 7.5%; P < 0.0001). In the hypothetical event that white blood cell count was 17,500/μL, a significantly lower proportion of physicians would ask for erythrocyte sedimentation rate (P < 0.017), C reactive protein (P < 0.0001), blood culture (P = 0.022), and urine analysis or dipstick (P = 0.028), if the child had received PCV. Only one third of participants routinely recommended PCV. Conclusion: Our data suggest that implementation of educational programs regarding the proper management of the febrile child is needed. Background The management of children with a fever without a source remains controversial [1], and it is becoming even more so after the introduction of the hepta-valent pneumococ- cal conjugate vaccine (PCV) [1]. It has been calculated that the widespread use of PCV is associated with a decreased risk of bacterial infection from about 2–5% to less than 1% in well-appearing young children with a fever without a source [1]. Given this minimal risk, some authors hope that the management of these children will become a Page 1 of 7 (page number not for citation purposes)