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Case-control study of hyperpyrexia in children
G Alpert1, E Hibbert, G R Fleisher
1Division of Emergency Medicine, Children's Hospital, Harvard Medical School, Boston, MA 02115.
Insights
Hyperpyrexia, or very high fever, in young children is not linked to higher rates of bacteremia or serious bacterial illness. These children require thorough evaluation but no special consideration beyond standard febrile child protocols.
Area of Science:
- Pediatrics
- Infectious Diseases
- Clinical Medicine
Background:
- Hyperpyrexia (temperature >= 41.1°C) is a concerning clinical sign in young children.
- The association between hyperpyrexia and serious bacterial infections, including bacteremia, requires clarification.
Purpose of the Study:
- To investigate the relationship between hyperpyrexia and the incidence of bacteremia and serious bacterial illness in pediatric patients.
- To determine if hyperpyrexic children warrant different diagnostic or management approaches compared to those with lower-grade fevers.
Main Methods:
- A retrospective case-control study was conducted.
- Seventy-six hyperpyrexic children (>= 41.1°C) were compared to age- and condition-matched controls with lower fevers (39.1-41.0°C).
- Diagnostic procedures, including blood cultures, urine cultures, chest X-rays, and white blood cell counts, were analyzed.
Main Results:
- Hyperpyrexic children underwent a significantly higher number of diagnostic procedures (P < 0.05).
- However, the frequency of serious bacterial infections and bacteremia did not significantly differ between hyperpyrexic children and controls (P > 0.05).
Conclusions:
- Hyperpyrexia in young children is not independently associated with an increased risk of bacteremia or serious bacterial illness.
- While thorough evaluation is necessary, hyperpyrexic children do not require special consideration beyond that given to any febrile child.
Abstract:
To test the association of hyperpyrexia (temperature greater than or equal to 41.1 degrees C) with increased rates of bacteremia and serious bacterial illness in young children, we performed a retrospective case-control study. Seventy-six hyperpyrexic children and an equal number of control cases with temperatures of 39.1-40 degrees C and 40.1-41.0 degrees C were identified. A significantly larger number of diagnostic procedures including blood cultures, urine cultures, chest x-rays and white blood cell counts were performed in the hyperpyrexic children (P less than 0.05). The frequency of serious bacterial infections and bacteremia did not differ among the groups (P greater than 0.05). Hyperpyrexic children need to be evaluated as thoroughly and carefully as any other febrile child but do not merit special consideration.