Are children with prolonged fever at a higher risk for serious illness? A prospective observational study.
Arch Dis Child
; 108(8): 632-639, 2023 08.
Article
em En
| MEDLINE
| ID: mdl-37185174
ABSTRACT
OBJECTIVES:
To describe the characteristics and clinical outcomes of children with fever ≥5 days presenting to emergency departments (EDs).DESIGN:
Prospective observational study.SETTING:
12 European EDs. PATIENTS Consecutive febrile children <18 years between January 2017 and April 2018.INTERVENTIONS:
Children 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 OUTCOMEMEASURES:
SBI and other non-infectious serious illness.RESULTS:
3778/35 705 (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.CONCLUSION:
Children 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.Palavras-chave
Texto completo:
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Base de dados:
MEDLINE
Assunto principal:
Infecções Bacterianas
/
Febre
Idioma:
En
Ano de publicação:
2023
Tipo de documento:
Article