Rochester Criteria for Febrile Infants

About this tool

The Rochester criteria were developed (Dagan et al. 1985) and validated (Jaskiewicz et al.1994) to identify febrile infants who were low-risk for serious bacterial illness.
The original study enrolled 233 previously healthy febrile infants < 90 days who had been admitted to hospital for suspected sepsis. 144 of these patients had all reassuring features categorizing them as “low-risk” as per the now deemed “Rochester criteria” and 1 infant in this low-risk group was found to have SBI (0.7%). 89 infants had one or more non-reassuring features categorizing them as “high-risk” and 22 were found to have SBI (24.7%).
The validation study narrowed the focus to febrile infants ≤ 60 days old and used a series of variables now deemed as the “Rochester criteria” to identify infants at low-risk to have SBI. Of the 511 infants who satisfied all of the low-risk criteria, 5/511 (1.0%) were found to have SBI, whereas of the 494 patients that had one or more high-risk features, 61 of them (12.3%) were found to have SBI. The Rochester criteria had a sensitivity of 92%, specificity of 55%, PPV of 12.3%, and NPV of 98.9%.
Clinical application of the Rochester criteria has typically used the validation study conclusions that previously healthy febrile infants ≤ 60 days old presenting to the ED are unlikely to have SBI if they have no high-risk variables as outlined in the Rochester criteria.
A score is assigned by the following variables.
Variable & Associated Points

Age ≤ 60 days
Rectal temperature ≥ 38 degrees Celsius in Emergency Department or parental history of equivalent rectal temperature
Infant appears generally well
Born at term (≥37 weeks’ gestation)
No perinatal antibiotics
No antibiotics at time of presentation or any time in life
Not treated for unexplained hyperbilirubinemia
No previous hospitalizations
No chronic or underlying illness
Not hospitalized longer than mother after delivery

No evidence of focal infection
* Including:
* Skin
* Soft tissue
* Bone
* Joint
* Ear


Normal Lab values including all of the following:
* WBC 5,000 – 15,000 mm³
* Band neutrophils ≤ 1,500 mm³
* Urine WBC ≤ 10 WBC / hpf
* If diarrhea present, fecal leukocytes ≤ 5 WBC / hpf


Results (either):
All reassuring findings are present (if yes to all questions)
Infant is Lower Risk for Serious Bacterial Infection. In the Rochester validation study, of the 511 infants who satisfied all of the low-risk criteria, 5/511 (1.0%) were found to have SBI. The NPV of the Rochester criteria for SBI is 98.9% (CI 95% 97.2-99.6).

Non-reassuring findings are present (if no to any one question)
Infant is Higher Risk for Serious Bacterial Infection. In the Rochester validation study, of the 494 patients that had one or more high-risk features, 61 of them (12.3%) were found to have SBI.

References
Dagan R, Powell KR, Hall CB, et al. 
Identification of infants unlikely to have serious bacterial infection although hospitalized for suspected sepsis. 
J Pediatr 1985;107:855–60

Jaskiewicz JA, McCarthy CA, Richardson AC, et al.
Febrile infants at low risk for serious bacterial infection–an appraisal of the Rochester criteria and implications for management.
Febrile Infant Collaborative Study Group. Pediatrics. 1994;94(3):390–6.