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Recommendations for Updating Fever and Inflammation of Unknown Origin From a Modified Delphi Consensus Panel
William F Wright1, Lauren Stelmash2, Albrecht Betrains3
1Division of Infectious Diseases, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
Open Forum Infectious Diseases
|July 5, 2024
Summary
New consensus recommendations for fever of unknown origin (FUO) and inflammation of unknown origin (IUO) were developed using a modified Delphi process. These guidelines aim to standardize diagnosis and management for clinicians and researchers.
Area of Science:
- Medical Diagnostics
- Clinical Practice Guidelines
- Epidemiology
Background:
- Fever of unknown origin (FUO) and inflammation of unknown origin (IUO) are common diagnostic challenges.
- Existing literature lacks standardized diagnostic approaches, necessitating consensus-based recommendations.
Purpose of the Study:
- To develop consensus-based recommendations for the diagnosis and management of FUO and IUO.
- To provide a standardized guide for clinicians, researchers, and patients.
Main Methods:
- A modified Delphi process involving 4 rounds of online surveys and 2 live video conferences.
- International experts were recruited based on peer-reviewed publications and studies.
- Consensus was sought on key themes related to FUO and IUO diagnosis and classification.
Main Results:
- Consensus was reached on incorporating epidemiologic factors, updated classification criteria, initial evaluation, diagnostic classification systems, and limiting empiric therapies.
- Experts disagreed on using FDG-PET/CT in FUO diagnostic criteria.
- Mixed opinions existed regarding temperature measurement site, illness duration, relapsing fever definitions, and unified FUO/IUO strategies.
Conclusions:
- Delphi-generated recommendations offer improvements over previous definitions for FUO and IUO.
- These guidelines serve as a valuable resource for clinical practice and future research in undiagnosed conditions.
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