Medizinische Universität Graz Austria/Österreich - Forschungsportal - Medical University of Graz
Gewählte Publikation:
SHR Neuro Krebs Kardio Lipid Stoffw Microb
Nijman, RG; Tan, CD; Hagedoorn, NN; Nieboer, D; Herberg, JA; Balode, A; von, Both, U; Carrol, ED; Eleftheriou, I; Emonts, M; van, der, Flier, M; de, Groot, R; Kohlmaier, B; Lim, E; Martinón-Torres, F; Pokorn, M; Strle, F; Tsolia, M; Yeung, S; Zachariasse, JM; Zavadska, D; Zenz, W; Levin, M; Vermont, CL; Moll, HA; Maconochie, IK, , PERFORM, consortium.
Are children with prolonged fever at a higher risk for serious illness? A prospective observational study.
Arch Dis Child. 2023; 108(8):632-639
Doi: 10.1136/archdischild-2023-325343
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PubMed
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- Co-Autor*innen der Med Uni Graz
- Kohlmaier Benno
- Zenz Werner
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- 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 OUTCOME MEASURES: 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.
- Find related publications in this database (using NLM MeSH Indexing)
- Child - administration & dosage
- Humans - administration & dosage
- Infant - administration & dosage
- Fever - diagnosis, epidemiology, etiology
- Bacterial Infections - complications, diagnosis, epidemiology
- C-Reactive Protein - metabolism
- Critical Care - administration & dosage
- Hospitalization - administration & dosage
- Emergency Service, Hospital - administration & dosage
- Find related publications in this database (Keywords)
- Child Health
- Emergency Care
- Epidemiology
- Infectious Disease Medicine
- Paediatric Emergency Medicine