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Are children with prolonged fever at a higher risk for serious illness? A prospective observational study

Ruud G Nijman1,2,3, Chantal D Tan4, Nienke N Hagedoorn4

  • 1Department of Paediatric Emergency Medicine, Division of Medicine, St. Mary's hospital - Imperial College NHS Healthcare Trust, London, UK r.nijman@imperial.ac.uk.

Archives of Disease in Childhood
|May 15, 2023
PubMed

Insights

Children with prolonged fever (≥5 days) face a higher risk of serious bacterial infection (SBI). Careful clinical assessment and diagnostic workup are crucial. Non-infectious causes of prolonged fever should also be considered.

Area of Science:

  • Pediatrics
  • Infectious Diseases
  • Emergency Medicine

Background:

  • Prolonged fever in children presenting to emergency departments (EDs) requires careful evaluation.
  • Understanding the risks associated with fever duration is essential for accurate diagnosis and management.

Purpose of the Study:

  • To characterize children with prolonged fever (≥5 days) in EDs.
  • To compare the clinical outcomes and risks of serious bacterial infection (SBI) in children with prolonged fever versus those with shorter fever durations.
  • To assess the diagnostic accuracy of non-specific symptoms, warning signs, and C-reactive protein (CRP) for identifying SBI.

Main Methods:

  • Prospective observational study conducted in 12 European EDs.
  • Included consecutive febrile children under 18 years old.
  • Compared children with fever ≥5 days to those with fever <5 days, analyzing SBI risk and diagnostic test performance.

Main Results:

  • 10.6% of febrile children had fever ≥5 days.
  • The incidence of SBI was higher in children with prolonged fever (8.4%) compared to those with shorter fever durations (5.7%).
  • While some warning signs were specific for SBI, they were infrequent. C-reactive protein <20 mg/L was effective in ruling out SBI. Non-infectious serious illnesses, including Kawasaki disease, were also identified.

Conclusions:

  • Children with prolonged fever have an increased risk of SBI, necessitating thorough clinical assessment and diagnostic evaluation.
  • Warning signs for SBI, though uncommon, increase the likelihood of infection. Non-infectious causes of prolonged fever, though rare, must be considered in the differential diagnosis.
Abstract

Keywords:
Child HealthEmergency CareEpidemiologyInfectious Disease MedicinePaediatric Emergency Medicine

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