Despite the objective of this study, I think that standardizing it for the first and second level of care is difficult due firstly to the technology used in these hospitals (x-rays, blood cultures and urine cultures) that although it seems incredible in many countries In developing countries including Ecuador, are not yet within the first level of care, even in some second level hospitals these equipment are obsolete or have de-calibrations; As well as indicates that this study was performed in patients of the same ethnicity, which is a factor that we do not know as it results in other countries in which there are multiple ethnicities within a single site, Finally the program for the collection of data was a computer program and in many places in my country Ecuador, clinical histories are still handwritten and not digital, which would complicate the process of standardization at these levels.

Enfermedad febril en niños

Strongly agree is a well-conducted study but one can not generalize to the first or second level because of existing limitations

Wilmer Sanango Reinoso