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Updated: Nov 30, 2025
A High-throughput Shigella-specific Bactericidal Assay
Published on: February 27, 2019
Shivering has little diagnostic value in diagnosing serious bacterial infection in children: a systematic review and
Maud Vandenberk1, Kasper De Bondt1, Emma Nuyts2
1KU Leuven, Leuven, Belgium.
Abstract:
Early diagnosis of serious bacterial infections (SBI) is important for improving outcome of morbidity and mortality in children. A systematic review was conducted to examine if shivering had any value in diagnosing serious bacterial infection. We split our population (0-18 years old) into two categories depending on the presence of a known malignancy. The databases of Medline, Embase, Cinahl, and Web of Science were searched from inception until July 2019. The quality was assessed with the QUADAS-2 tool. Two by two tables were created, extracting the number of true positive (TP), true negative (TN), false positive (FP), and false negative (FN) regarding shivering and SBI, by 2 authors independently. Sensitivity, specificity, likelihood ratios, and their 95% confidence intervals were calculated using the MetaDATA Shiny app. In a population with known malignancy, we found a +LR of 3.47 (95% CI 2.58-4.36) for a serious bacterial infection when shivering was present, implying an increase of 25-30% possibility for a serious bacterial infection. In children without malignancy, diagnostic accuracy of shivering was poor.Conclusion: Shivering is of limited use to diagnose serious bacterial infection in children without malignancy. Nevertheless, in children with known malignancy, it can be useful as an alarm signal. What is Known: • In the NICE guidelines for febrile illness in children, "shivering" is considered as an intermediate risk factor ("amber" sign) for a serious illness. • A systematic literature search conducted in 2007 investigating the correlation between shivering in a febrile child and the presence of a serious bacterial infection could include only one study. What is New: • Based on the results of this systematic review, shivering has little diagnostic value in children without malignancy but can be useful as an alarm sign of serious bacterial infection in children with known malignancy. • In case of absence of shivering, serious bacterial infection cannot be ruled out.
Insights
Shivering is a poor indicator for serious bacterial infections (SBI) in children without cancer. However, in children with known malignancy, shivering can serve as a valuable alarm sign for SBI.
Area of Science:
- Pediatric Infectious Diseases
- Diagnostic Accuracy Studies
- Systematic Reviews
Background:
- Early diagnosis of serious bacterial infections (SBI) is crucial for reducing childhood morbidity and mortality.
- Shivering is recognized as an intermediate risk factor for serious illness in pediatric fever guidelines.
- Previous research on shivering as a diagnostic marker for SBI in children was limited.
Purpose of the Study:
- To systematically review the diagnostic value of shivering for identifying serious bacterial infections in children.
- To stratify the analysis based on the presence or absence of a known malignancy in pediatric patients.
Main Methods:
- A systematic review of Medline, Embase, Cinahl, and Web of Science databases was performed up to July 2019.
- Studies included children aged 0-18 years, categorized by malignancy status.
- Data extraction included true positives, true negatives, false positives, and false negatives; quality was assessed using QUADAS-2.
Main Results:
- In children with known malignancy, shivering was associated with a positive likelihood ratio of 3.47 (95% CI 2.58-4.36) for SBI, indicating a 25-30% increased probability.
- The diagnostic accuracy of shivering for SBI was found to be poor in children without a known malignancy.
- Absence of shivering does not rule out the possibility of a serious bacterial infection.
Conclusions:
- Shivering has limited utility in diagnosing serious bacterial infections in children without malignancy.
- In pediatric patients with a known malignancy, shivering can function as an important alarm signal for potential SBI.
- Further investigation may be warranted to refine the role of shivering in specific high-risk pediatric populations.
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