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Predicting prolonged duration of fever in children: a cohort study in primary care

Gijs Elshout¹, Marijke Kool¹, Arthur M Bohnen¹

¹Department of General Practice, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands.

The British Journal of General Practice : the Journal of the Royal College of General Practitioners

|September 2, 2015

Insights

In primary care, sore throat and palpable lymph nodes may indicate prolonged fever in children. C-reactive protein (CRP) does not improve fever duration prediction.

Area of Science:

Pediatrics
Infectious Diseases
Primary Care Medicine

Background:

Fever is a common concern for parents in primary care settings.
Identifying predictors of prolonged fever duration can help reassure parents and reduce unnecessary healthcare consultations.

Purpose of the Study:

To identify clinical signs and symptoms predicting prolonged fever in children.
To assess the added predictive value of C-reactive protein (CRP) measurements.

Main Methods:

Prospective cohort study conducted in a general practitioner cooperative (GPC) out-of-hours service.
Included children aged 3 months to 6 years presenting with parental-reported fever.
Main outcome: prolonged fever duration (>3 days) after initial contact.

Main Results:

Sore throat (OR 2.8) and palpable lymph nodes (OR 1.87) were predictive of prolonged fever.
The predictive model had low discriminative value (AUC 0.64).
C-reactive protein (CRP) showed no additive value in predicting fever duration.

Conclusions:

Few clinical signs and symptoms accurately predict prolonged fever duration in children.
CRP measurement does not enhance the prediction of fever duration.
The low discriminative value of the model limits accurate prediction of fever duration.

Read full analysis

Abstract

Background:

Fever in children in primary care is commonly caused by benign infections, but often worries parents. Information about the duration of fever and its predictors may help in reassuring parents, leading to diminished consultation of health care.

Aim:

To determine which signs and symptoms predict a prolonged duration of fever in febrile children in primary care and evaluate whether C-reactive protein (CRP) measurement has an additive predictive value for these symptoms.

Design And Setting:

A prospective cohort study at a GPs' cooperative (GPC) out-of-hours service.

Method:

Children (aged 3 months to 6 years) presenting with fever as stated by the parents were included. Exclusion criteria were no communication in Dutch possible, previous enrolment in the study within 2 weeks, referral to the hospital directly after visiting the GPC, or no informed consent. The main outcome measure was prolonged duration of fever (>3 days) after initial contact.

Results:

Four-hundred and eighty children were analysed, and the overall risk of prolonged duration was 13% (63/480). Multivariate analysis combined model of patient history and physical examination showed that 'sore throat' (OR 2.8; 95% CI = 1.30 to 6.01) and 'lymph nodes palpable' (OR 1.87; 95% CI = 1.01 to 3.49) are predictive for prolonged duration of fever. The discriminative value of the model was low (AUC 0.64). CRP had no additive value in the prediction of prolonged duration of fever (OR 1.00; 95% CI = 0.99 to 1.01).

Conclusion:

The derived prediction model indicates that only a few signs and symptoms are related to prolonged duration of fever. CRP has no additional value in this model. Overall, because the discriminative value of the model was low, the duration of fever cannot be accurately predicted.

Keywords:

child child, preschool family practice fever infant primary care signs and symptoms

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