RT Journal Article
SR Electronic
T1 Are children with prolonged fever at a higher risk for serious illness? A prospective observational study
JF Archives of Disease in Childhood
JO Arch Dis Child
FD BMJ Publishing Group Ltd and Royal College of Paediatrics and Child Health
SP 632
OP 639
DO 10.1136/archdischild-2023-325343
VO 108
IS 8
A1 Ruud G Nijman
A1 Chantal D Tan
A1 Nienke N Hagedoorn
A1 Daan Nieboer
A1 Jethro Adam Herberg
A1 Anda Balode
A1 Ulrich von Both
A1 Enitan D Carrol
A1 Irini Eleftheriou
A1 Marieke Emonts
A1 Michiel van der Flier
A1 Ronald de Groot
A1 Benno Kohlmaier
A1 Emma Lim
A1 Federico Martinón-Torres
A1 Marko Pokorn
A1 Franc Strle
A1 Maria Tsolia
A1 Shunmay Yeung
A1 Joany M Zachariasse
A1 Dace Zavadska
A1 Werner Zenz
A1 Michael Levin
A1 Clementien L Vermont
A1 Henriette A Moll
A1 Ian K Maconochie
A1 ,
YR 2023
UL http://adc.bmj.com/content/108/8/632.abstract
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).