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Resolution of Fever in the Pediatric Emergency Department and Bacteremia

Alexandra H Baker1,2, Michael C Monuteaux1, Kenneth A Michelson1,2

  • 1Division of Emergency Medicine, Department of Pediatrics, Boston Children's Hospital, Boston, MA, USA.

Clinical Pediatrics
|November 19, 2022
PubMed

Insights

Children with persistent fever after antipyretic medication are more likely to have bacteremia. This study highlights the importance of monitoring fever response in pediatric emergency departments to identify potential bloodstream infections.

Area of Science:

  • Pediatric Emergency Medicine
  • Infectious Diseases
  • Clinical Microbiology

Background:

  • Fever is a common symptom in children presenting to emergency departments.
  • Antipyretics are frequently used to manage fever.
  • The association between fever resolution and underlying bacteremia requires further investigation.

Purpose of the Study:

  • To investigate the relationship between the lack of fever response to antipyretics and the presence of bacteremia in children.
  • To determine if persistent fever after antipyretic administration is a predictor of bacteremia.

Main Methods:

  • Cross-sectional study design.
  • Inclusion of children with initial temperature ≥38°C presenting to a pediatric emergency department (ED).
  • Analysis of blood cultures and fever resolution at 180 and 240 minutes post-antipyretic administration, adjusting for covariates.

Main Results:

  • Out of 6319 febrile children, 242 (3.8%) had bacteremia.
  • Children remaining febrile at 180 minutes had an adjusted odds ratio of 1.6 for bacteremia.
  • Children remaining febrile at 240 minutes had an adjusted odds ratio of 1.7 for bacteremia.

Conclusions:

  • Lack of fever resolution following antipyretic use is associated with a higher likelihood of bacteremia in children.
  • Persistent fever in pediatric ED patients may indicate underlying bloodstream infections.
  • Monitoring antipyretic response is crucial for identifying children with bacteremia.

Keywords:
antipyreticsbacteremiaemergency medicinefeverpediatrics

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