[Fever in Emergency Department: screening for severe disease]

To identify variables associated to severe disease in adult patients with fever in the Emergency Department.

Observational, perspective study. Data from all the adult patients with fever (axillary temperature 37.8 degrees C or higher) seen in the medical area of the Emergency Department was collected from January 28th to April 30th of 2006 and included in a logistic regression analysis, the dependent variable being "severe disease". Based on the corresponding risk, a score was assigned to each variable to design a risk of severe disease model.

A total of 11271 patients were seen, 786 (7.0%) of whom had fever. Median age was 39 years (37-40), 57% male. Of these, 31% were admitted and 27% had severe disease. Based on the symptoms and signs, upper airways infection was suspected in 309 (39%) and lower airways infection in 130 (17%), abdominal infection in 117 (15%), urinary tract infection in 40 (5%) and no source of infection in 145 (18%). Comorbidity (OR 3.6, 95% CI -1.8-7.2) (4 points), C-reactive protein higher than 10 mg/dl (OR 1.8, 95% CI 1.1-3.7) (2 points) and age (OR 1.02, 95% CI 1.01-1.04) (age older than 60 years 3 points) were associated with severe disease. Fever having a probable upper respiratory origin was a protector factor (OR 0.4, 95% CI 0.2-0.9) (fever from other foci 3 points). Three percent of the patients with less than 3 points had severe disease versus 72% with more than 7 points.

Comorbidity, C-reactive protein higher than 10 mg/dl, age and suspicion of source of infection different of upper airways infection were associated to severe disease in adults with fever in the Emergency Department.