Aims To evaluate what proportion of children with rigors seen in a busy Paediatric Unit had severe bacterial illness.

Methods A prospective audit was done in a hospital where local protocol includes rigors as a red sign in addition to the signs suggested by NICE guidelines for feverish illness in children. 43 children with rigors seen during the 10 week audit period were included.

Results 51 patients were identified of which 43 notes were found and included. Age range was between 5 months to 15 years. 60% had a temperature of >39C. 65% had just one episode of rigor and <10% had more than 2 episodes of rigor.

Blood cultures were negative in all cases apart from one contaminant in a well patient who grew a Streptococcus viridians.

Of the 43 patients, 18 (41%) children were treated as having a bacterial illness. 9 had culture positive UTIs, one had clear signs of pyelonephritis although cultures were negative, 1 had dysentery and 7 had chest signs and chest X ray changes consistent with chest infection with one of these being PCR positive for Pneumococcus.

Only 5 (11%) of those found to have a focus had another red or amber NICE guidelines sign.

Conclusion In our audit, of the 18 (41%) of children with feverish illness and rigors were treated as having a bacterial focus, of which, only 5 (11%) had a red or amber signs suggested by current NICE guidance. Including Rigor as an amber sign in the NICE guidance would prompt health practitioners to observe and investigate these children who have a high likelihood of having a bacterial illness.