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Height of fever and invasive bacterial infection
  1. Kenneth A Michelson1,
  2. Mark I Neuman1,
  3. Christopher M Pruitt2,
  4. Sanyukta Desai3,
  5. Marie E Wang4,
  6. Adrienne G DePorre5,
  7. Rianna C Leazer6,
  8. Laura F Sartori7,
  9. Richard D Marble8,
  10. Sahar N Rooholamini9,
  11. Christopher Woll10,
  12. Fran Balamuth11,
  13. Paul L Aronson10
  14. on behalf of the Febrile Young Infant Research Collaborative
    1. 1Division of Emergency Medicine, Boston Children's Hospital, Boston, Massachusetts, USA
    2. 2Division of Pediatric Emergency Medicine, Department of Pediatrics, University of Alabama at Birmingham, Birmingham, Alabama, USA
    3. 3Division of Hospital Medicine, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
    4. 4Division of Pediatric Hospital Medicine, Department of Pediatrics, Stanford University School of Medicine, Stanford, California, USA
    5. 5Division of Hospital Medicine, Department of Pediatrics, Children's Mercy Hospital, Kansas City, Missouri, USA
    6. 6Division of Hospital Medicine, Department of Pediatrics, Children's Hospital of The King's Daughters, Norfolk, Virginia, USA
    7. 7Division of Pediatric Emergency Medicine, Department of Pediatrics, Monroe Carell Jr. Children’s Hospital at Vanderbilt, Nashville, Tennessee, USA
    8. 8Division of Emergency Medicine, Department of Pediatrics, Ann and Robert H Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
    9. 9Division of Hospital Medicine, Department of Pediatrics, Seattle Children's Hospital, Seattle, Washington, USA
    10. 10Section of Pediatric Emergency Medicine, Departments of Pediatrics and Emergency Medicine, Yale School of Medicine, New Haven, Connecticut, USA
    11. 11Division of Emergency Medicine, Department of Pediatrics, Center for Pediatric Clinical Effectiveness, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
    1. Correspondence to Dr Paul L Aronson, Pediatrics and Emergency Medicine, Yale University School of Medicine, New Haven, CT 06510, USA; paul.aronson{at}yale.edu

    Abstract

    Objective We aimed to evaluate the association of height of fever with invasive bacterial infection (IBI) among febrile infants <=60 days of age.

    Methods In a secondary analysis of a multicentre case–control study of non-ill-appearing febrile infants <=60 days of age, we compared the maximum temperature (at home or in the emergency department) for infants with and without IBI. We then computed interval likelihood ratios (iLRs) for the diagnosis of IBI at each half-degree Celsius interval.

    Results The median temperature was higher for infants with IBI (38.8°C; IQR 38.4–39.2) compared with those without IBI (38.4°C; IQR 38.2–38.9) (p<0.001). Temperatures 39°C–39.4°C and 39.5°C–39.9°C were associated with a higher likelihood of IBI (iLR 2.49 and 3.40, respectively), although 30.4% of febrile infants with IBI had maximum temperatures <38.5°C.

    Conclusions Although IBI is more likely with higher temperatures, height of fever alone should not be used for risk stratification of febrile infants.

    • accident & emergency
    • infectious diseases
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    Footnotes

    • Correction notice This paper has been corrected since it was published online. A degree symbol has been added before the ‘C’.

    • Collaborators The following collaborators in the Febrile Young Infant Research Collaborative acquired data for this study and/or contributed to the parent study: Elizabeth R Alpern, MD, MSCE (Ann and Robert H Lurie Children’s Hospital of Chicago, Chicago, Illinois), Whitney L Browning, MD (Vanderbilt University School of Medicine, Nashville, Tennessee), Elana A Feldman, MD (Lucile Packard Children’s Hospital Stanford, Palo Alto, California), Catherine E Lumb, MD (University of Alabama at Birmingham, Birmingham, Alabama), Russell J McCulloh, MD (Children’s Mercy Hospital, Kansas City, Missouri), Christine E Mitchell, BSN (Children's Hospital of Philadelphia, Philadelphia, Pennsylvania), Lise E Nigrovic, MD, MPH (Boston Children’s Hospital, Boston, Massachusetts), Nipam Shah, MBBS, MPH (University of Alabama at Birmingham, Birmingham, Alabama), Samir S Shah, MD, MSCE (University of Cincinnati College of Medicine, Cincinnati, Ohio), Sarah J Shin, BSN (Children's Hospital of Philadelphia, Philadelphia, Pennsylvania), and Derek J Williams, MD, MPH (Vanderbilt University School of Medicine, Nashville, Tennessee).

    • Contributors Study concept and design: KAM, MIN, PLA. Data acquisition: MIN, CMP, SD, MEW, AGD, RCL, LFS, RDM, SNR, CW, FB, PLA. Data analysis: KAM, PLA. Interpretation of data: all authors. Drafting of the initial manuscript: KAM, PLA. Critical revision of the manuscript for important intellectual content: all authors. Statistical analysis: KAM. Study supervision: PLA. Approval of the final manuscript for submission and agreement to be accountable for all aspects of the work: all authors.

    • Funding This project was supported by grant numbers K08HS026503 (KM) and K08HS026006 (PA) from the Agency for Healthcare Research and Quality (AHRQ) and by CTSA grant number KL2 TR001862 (PA) from the National Center for Advancing Translational Sciences (NCATS), a component of the National Institutes of Health (NIH). The content is solely the responsibility of the authors and does not represent the official views of AHRQ or NIH.

    • Competing interests None declared.

    • Patient consent for publication Not required.

    • Ethics approval The parent study was approved by each hospital’s institutional review board.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data availability statement De-identified data are available upon reasonable request if a data use agreement is executed between the requesting institution and Yale.

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