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High fever in young children, known as hyperpyrexia, rarely indicates serious illness. Clinical evaluation, not routine tests, should guide medical decisions for febrile children.
Area of Science:
- Pediatrics
- Infectious Diseases
- Emergency Medicine
Background:
- Hyperpyrexia, defined as a temperature of 41.1°C (106°F) or higher, is a concerning symptom in children.
- Previous assumptions may link high fever directly to severe underlying conditions.
Purpose of the Study:
- To determine the incidence of serious illness in children under two years presenting with hyperpyrexia.
- To evaluate whether high fever alone is a reliable indicator of severe pediatric illness.
Main Methods:
- A prospective study was conducted over one year at a children's hospital emergency department.
- Nineteen children under two years with hyperpyrexia were identified and followed.
- Diagnoses were recorded, and patient outcomes were monitored.
Main Results:
- The incidence of serious illness solely indicated by high fever was found to be no higher than 0.15.
- Diagnoses included common conditions like otitis media, pneumonia, and gastroenteritis.
- No cases of meningitis or death occurred; only one child required hospitalization.
Conclusions:
- The presence of hyperpyrexia in young children does not necessarily signify a serious underlying illness.
- Clinical assessment should guide decisions regarding laboratory work-up and hospitalization for febrile children.
- Routine diagnostic testing and admission based solely on high fever are not supported by this study's findings.
Abstract:
A prospective study was done to determine the incidence of serious illness in children under two years of age with hyperpyrexia (temperature of 41.1 degrees C [106 degrees F] or greater). Nineteen children were seen and followed in the emergency department of Oklahoma Children's Memorial Hospital over a one-year period. The final clinical diagnoses included acute otitis media, pneumonia, acute gastroenteritis, roseola, and cellulitis of the leg. In the entire group there was no meningitis or subsequent death. One child was hospitalized. The statistical analysis (binomial test at the 0.05 level) confirms that the incidence of serious illness manifested only by high fever is no higher than 0.15. The mere presence of very high fever does not necessarily indicate a serious illness. Laboratory and other diagnostic work-up and hospitalization should be based on clinical evaluations, rather than done routinely.