Diagnosing unexplained fever: can quick diagnosis units replace inpatient hospitalization?

Area of Science:

• Internal Medicine
• Infectious Diseases
• Health Economics

Background:

• Outpatient quick diagnosis units (QDUs) are emerging as an alternative to hospitalization for diagnosing serious conditions.
• Prospective evaluation of QDUs for diagnosing unexplained fever (FUN) is lacking.

Purpose of the Study:

• To prospectively assess the utility and cost-effectiveness of QDUs for diagnosing fever of uncertain nature (FUN).
• To compare QDU patients with hospitalized patients diagnosed with FUN.

Main Methods:

• Prospective assessment of 176 patients referred to QDUs for FUN (temperature >38°C for ≥1 week, no prior diagnosis).
• Comparison with 168 hospitalized patients with FUN during the same period.
• Micro-costing analysis of QDU versus hospital costs.

Main Results:

• QDU patients were younger, required fewer investigations, and had a higher prevalence of viral infections (36% vs. 8%) but lower prevalence of bacterial infections (6% vs. 46%) and malignancies (2% vs. 14%) compared to controls.
• Time-to-diagnosis was longer in QDUs (25.82 days) versus length-of-stay in hospitals (12.89 days), though 56% of QDU patients needed only 1-2 visits.
• Cost per QDU patient (€644.59) was substantially lower than per hospitalized patient (€4404.64).

Conclusions:

• QDUs are effective for diagnosing less severe cases of unexplained fever, characterized by more viral and fewer bacterial infections and malignancies.
• While time-to-diagnosis can be longer in QDUs, significant cost savings are achieved.
• Objective tools are needed to assess patient severity for optimal diagnostic setting selection.