학술논문
Are children with prolonged fever at a higher risk for serious illness? A prospective observational study
Document Type
Article
Author
Nijman, Ruud G; Tan, Chantal D; Hagedoorn, Nienke N; Nieboer, Daan; Herberg, Jethro Adam; Balode, Anda; von Both, Ulrich; Carrol, Enitan D; Eleftheriou, Irini; Emonts, Marieke; van der Flier, Michiel; de Groot, Ronald; Kohlmaier, Benno; Lim, Emma; Martinón-Torres, Federico; Pokorn, Marko; Strle, Franc; Tsolia, Maria; Yeung, Shunmay; Zachariasse, Joany M; Zavadska, Dace; Zenz, Werner; Levin, Michael; Vermont, Clementien L; Moll, Henriette A; Maconochie, Ian K
Source
Archives of Disease in Childhood; 2023, Vol. 108 Issue: 8 p632-639, 8p
Subject
Language
ISSN
00039888; 14682044
Abstract
ObjectivesTo describe the characteristics and clinical outcomes of children with fever ≥5 days presenting to emergency departments (EDs).DesignProspective observational study.Setting12 European EDs.PatientsConsecutive febrile children <18 years between January 2017 and April 2018.InterventionsChildren with fever ≥5 days and their risks for serious bacterial infection (SBI) were compared with children with fever <5 days, including diagnostic accuracy of non-specific symptoms, warning signs and C-reactive protein (CRP; mg/L).Main outcome measuresSBI and other non-infectious serious illness.Results3778/35 705 (10.6%) of febrile children had fever ≥5 days. Incidence of SBI in children with fever ≥5 days was higher than in those with fever <5 days (8.4% vs 5.7%). Triage urgency, life-saving interventions and intensive care admissions were similar for fever ≥5 days and <5 days. Several warning signs had good rule in value for SBI with specificities >0.90, but were observed infrequently (range: 0.4%–17%). Absence of warning signs was not sufficiently reliable to rule out SBI (sensitivity 0.92 (95% CI 0.87–0.95), negative likelihood ratio (LR) 0.34 (0.22–0.54)). CRP <20 mg/L was useful for ruling out SBI (negative LR 0.16 (0.11–0.24)). There were 66 cases (1.7%) of non-infectious serious illnesses, including 21 cases of Kawasaki disease (0.6%), 28 inflammatory conditions (0.7%) and 4 malignancies.ConclusionChildren with prolonged fever have a higher risk of SBI, warranting a careful clinical assessment and diagnostic workup. Warning signs of SBI occurred infrequently but, if present, increased the likelihood of SBI. Although rare, clinicians should consider important non-infectious causes of prolonged fever.