Characteristics of children with prolonged fever and their outcomes compared with children with shorter duration of fever
| All children with fever <5 days n=31 927 (89.4%)* | All children with fever ≥5 days n=3778 (10.6%)* | P value | ||
| General characteristics | ||||
| Age | Median (IQR) | 2.7 (1.3–5.5) | 3.0 (1.5–6.0) | <0.001 |
| Sex | Female, n (%) | 14 416 (45) | 1720 (46) | 0.68 |
| Previous visit to any healthcare provider in the last 7 days | n (%) | 7062 (23) | 1929 (55) | <0.001 |
| Referral | n (%) | 13 225 (43) | 1759 (48) | <0.001 |
| Comorbidity | n (%) | 5240 (17) | 583 (16) | 0.13 |
| Triage urgency classification | Emergent–very urgent | 3190 (10%) | 241 (6%) | <0.001 |
| Urgent | 7931 (25%) | 903 (24%) | ||
| Standard–non-urgent | 19 960 (63%) | 2527 (67%) | ||
| Duration of fever | Days, median (IQR) | 3 (3–4) | 6 (5–7) | <0.001 |
| Non-specific signs and symptoms | ||||
| Respiratory signs and symptoms | Any | 9927 (37%) | 1560 (50%) | <0.001 |
| Gastrointestinal signs and symptoms | Any | 9677 (34%) | 1133 (34%) | 0.61 |
| Other type of rash† | Any | 2806 (10%) | 479 (14%) | <0.001 |
| Warning signs and symptoms | ||||
| Ill appearance | n (%) | 5101 (17) | 599 (17) | 0.97 |
| Tachypnoea (breaths/min) | APLS thresholds, n (%) | 6139 (33) | 644 (32) | 0.19 |
| Tachycardia (beats/min) | APLS thresholds, n (%) | 10 524 (42) | 993 (33) | <0.001 |
| Prolonged capillary refill | ≥3 s, n (%) | 354 (1) | 53 (2) | 0.07 |
| Oxygen saturations (%O2) | <94%O2, n (%) | 636 (3) | 126 (4) | <0.001 |
| Level of consciousness | Decreased (verbal, pain, unresponsive), n (%) | 166 (1) | 14 (0.4) | 0.27 |
| Increased work of breathing | n (%) | 4768 (17) | 481 (15) | 0.005 |
| Non-blanching rash | n (%) | 926 (3) | 90 (3) | 0.09 |
| Neurological signs | n (%) | 210 (1) | 24 (1) | 1.00 |
| Seizures | n (%) | 1261 (4) | 42 (1) | <0.001 |
| Diagnostics | ||||
| C-reactive protein | mg/L, median (IQR) | 17 (5–48) | 23 (6–64) | <0.001 |
| Laboratory testing at ED | Any, n (%) | 14 412 (45) | 2200 (58) | <0.001 |
| Imaging at ED | Any, n (%) | 5375 (17) | 1121 (30) | <0.001 |
| Treatment and outcomes | ||||
| Immediate life-saving interventions‡ | Any, n (%) | 513 (2) | 50 (1) | 0.21 |
| Antibiotics prescribed this attendance | Any, n (%) | 9857 (31) | 1560 (42) | <0.001 |
| Diagnosis—focus of infection | Upper respiratory tract | 17 157 (54%) | 1861 (49%) | <0.001 |
| Lower respiratory tract | 4295 (13%) | 838 (22%) | ||
| Gastrointestinal | 3417 (11%) | 191 (5%) | ||
| Urinary tract | 1104 (3%) | 152 (4%) | ||
| Childhood exanthema | 1511 (5%) | 221 (6%) | ||
| Soft tissue or musculoskeletal | 748 (2%) | 92 (2%) | ||
| Sepsis or meningitis | 236 (1%) | 22 (1%) | ||
| Undifferentiated fever | 2559 (8%) | 247 (7%) | ||
| Inflammatory, other | 877 (3%) | 151 (4%) | ||
| Diagnosis | Serious bacterial infection | 1812 (5.7%) | 319 (8.4%) | <0.001 |
| Invasive bacterial infection | 129 (0.4%) | 15 (0.4%) | 1.00 | |
| Disposition | Discharge without follow-up | 11 393 (36%) | 1307 (35%) | 0.04 |
| Discharge with follow-up | 12 288 (38%) | 1410 (37%) | ||
| Admission <24 hours | 1546 (5%) | 189 (5%) | ||
| Admission 24 hours or more | 5974 (19%) | 787 (21%) | ||
| Admission, duration unknown | 370 (1%) | 45 (1%) | ||
| PICU or death§ | 125 (0.4%) | 18 (0.5%) | ||
| Left without being seen | 190 (1%) | 15 (0%) |
*The MOFICHE study included a total of 38 480 febrile children7; n=2775 (7%) were excluded because of missing data on duration of fever.
†This excludes any non-blanching rash including petechiae and purpura.
‡Immediate life-saving interventions (ILSI): airway and breathing support (non-rebreathing mask, (non-invasive) ventilation, intubation), emergency procedures (chest needle decompression, pericardiocentesis or open thoracotomy), haemodynamic support (fluid bolus (>10 mL/kg) or blood administration) or emergency medication (naloxone, dextrose, atropine, adenosine, epinephrine or vasopressors).
§In total, 1 death was recorded in the MOFICHE study, which had a duration of fever <5 days.
APLS, advanced paediatric life support; ED, emergency department; MOFICHE, Management and Outcome of Fever in Children in Europe; PICU, paediatric intensive care unit.