发烧是向小儿急诊部门（ED）介绍的常见原因，占所有访问的约20％。大多数发烧的儿童患有自限性病毒疾病；但是，严重的细菌感染可能导致几乎相同的临床表现，从而使诊断成为艰巨的任务。
Because of the catastrophic consequences of missing a potentially life-threatening bacterial infection, a cautious approach to the management of the child with fever is often taken, involving extended observation, investigations, and precautionary use of antibiotics, often without definitive evidence of bacterial infections.
从个人，家庭，社会和资源的角度来看，缺少严重细菌感染病例的成本很大
这些威胁生命的感染代表了干草堆中的针头，临床医生的挑战是尽早确定患有严重细菌感染（SBI）的儿童，以便可以进行紧急治疗。真正的问题是从猫猫中清除老虎，因为婴儿老虎可能很容易被误认为是猫猫，但是一旦生长，它就会成长为一种凶猛的野兽，能够造成严重伤害。
判断很困难，而且通常缺少重要的线索。有了经验，可以提高对正确诊断的信心，但是即使到那时，临床判断中可能存在错误的可能性。从个人，家庭，社会和资源的角度来看，缺少SBI案件的成本很大。
The cases of missed life-threatening SBI with catastrophic consequences are the cases we all remember. These are the cases which are reported in the media, and which provoke such fear and anxiety amongst parents and carers.
Not surprisingly, doctors working on the frontline, where febrile children are assessed, are also plagued with these fears. Doctors choose a career in medicine because they desire to alleviate human suffering, and the thought of ending up before a tribunal for negligence, is nothing short of a worst nightmare. The reality however, is that fatal SBI represents the tip of the iceberg, yet the fear of this extremely rare event drives a lot of clinician behavior in the assessment of the febrile child.
Diagnosis
The lack of gold standard diagnostic tests which accurately distinguish SBI from viral infections presents a dilemma for clinicians. On one hand, there is the fear of misdiagnosis, parental anxiety and unrealistic public expectations that doctors should always have the answer. On the other hand, the reality is that most of these febrile illnesses are viral and will get better on their own.
这种不确定性导致一种谨慎的方法，进一步研究，抗生素“以防万一”，以及静脉注射抗生素观察的医院入院，当时不确定性和风险被认为是最高的。
Hospital admission is undoubtedly the safest option because any further deterioration will hopefully be monitored and urgent interventions can be instituted. However, this “safest option” is not without consequences: overuse of antibiotics, rising antimicrobial resistance and significant cost to the child, family, society and the NHS.
Increasing efficiency, reducing antibiotic use
大, real-life study in Liverpool在欧洲最繁忙的儿童急诊室之一的6500多名儿童中，我们试图确定诊断不确定性在评估高温儿童时的潜在经济影响。该研究收集了有关在12个月内向大型儿童培养出来的所有发热儿童的数据。我们问的问题是：“如果有准确而快速的诊断测试可以自信地排除威胁生命的SBI，这会有什么区别？”。
抗菌素抵抗是日益增长的全球健康危机，需要紧急采取集体行动。结合使用，迫切需要降低成本并提供效率的倡议，在现金短缺的卫生系统中，例如NHS，需求超出需求不断增长。
If the cost of the uncertainty is significant, then the message to payers, providers and the diagnostic companies is still relevant. In order to make a difference, in high income countries, the diagnostic test does not need to be cheap; it needs to highly accurate, rapid, easy to use and widely available.
Our studyshows that the difference in healthcare resources and costs, between a child with a self-limiting viral illness who receives antibiotics and additional investigations, and a child who does not, is over £1,000. For infants under 3 months, where the risks of SBI are greatest, the difference in spending is even higher at over £2000.
Had an accurate diagnostic test been available, antibiotic use could potentially have been reduced by about 60%
If you scale these figures up to a medium-sized ED that sees 4000 febrile children a year, typical in many parts of England, it amounts to a staggering £1.3 million additional spending per NHS Trust each year. That is enough to fund, for example, an extra 25 band-6 nurses every year.
除了降低成本外，如果可以进行准确的诊断测试，则可能将抗生素使用降低约60％。这些数字在一个不断上升的抗菌素耐药威胁到现代医学的核心时代令人震惊。
该研究强调了准确的新诊断测试可以在ED中发挥作用，改善家庭的护理和便利性的作用，这不仅在减少不必要的抗生素使用方面，而且在提高NHS服务的效率和适当性方面。如果新的诊断测试使我们能够将调查，抗生素和医院病床靶向最大受益的人；这释放了这些资金，可以在其他地方充分利用；同时还要尽快让父母放心。
This research was conducted in a high-income country, but this is very much a global problem. New and better diagnostics, especially if they are affordable, will potentially have huge benefits for our health services world-wide, particularly in resource-poor settings, like in sub-Sahara Africa and rural Asia. 21stcentury global health challenges such as rising antimicrobial resistance cannot be tackled in isolation; they deserve global partnerships,像表演联盟.
新颖的诊断测试将有助于从猫猫中分解老虎，增加对抗生素和调查的信心，并在那些儿童中产生可观的效率增长，因为那些发现未能识别潜在潜在危及生命的细菌感染的风险是最大的。
注释