PT  - JOURNAL ARTICLE
AU  - Ruud G Nijman
AU  - Chantal D Tan
AU  - Nienke N Hagedoorn
AU  - Daan Nieboer
AU  - Jethro Adam Herberg
AU  - Anda Balode
AU  - Ulrich von Both
AU  - Enitan D Carrol
AU  - Irini Eleftheriou
AU  - Marieke Emonts
AU  - Michiel van der Flier
AU  - Ronald de Groot
AU  - Benno Kohlmaier
AU  - Emma Lim
AU  - Federico Martinón-Torres
AU  - Marko Pokorn
AU  - Franc Strle
AU  - Maria Tsolia
AU  - Shunmay Yeung
AU  - Joany M Zachariasse
AU  - Dace Zavadska
AU  - Werner Zenz
AU  - Michael Levin
AU  - Clementien L Vermont
AU  - Henriette A Moll
AU  - Ian K Maconochie
ED  - ,
TI  - Are children with prolonged fever at a higher risk for serious illness? A prospective observational study
AID  - 10.1136/archdischild-2023-325343
DP  - 2023 Aug 01
TA  - Archives of Disease in Childhood
PG  - 632--639
VI  - 108
IP  - 8
4099  - http://adc.bmj.com/content/108/8/632.short
4100  - http://adc.bmj.com/content/108/8/632.full
SO  - Arch Dis Child2023 Aug 01; 108
AB  - 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.Data are available in a public, open access repository. Data are available in a public, open access repository. A data set containing individual participant data will be made available in a public data repository containing a specific DOI. The data will be anonymised and will not contain any identifiable data. The data manager of the PERFORM consortium can be contacted for inquiries (tisham.de@imperial.ac.uk).