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Association of temperature greater than 41.1 degrees C (106 degrees F) with serious illness
Insights
Children with high fever (rectal temperature > 41.1°C) face significant risks of serious illness, including sepsis and meningitis. Prompt evaluation is crucial for early diagnosis and management of potentially life-threatening conditions.
Area of Science:
- Pediatrics
- Emergency Medicine
- Infectious Diseases
Background:
- Fever is a common presenting symptom in pediatric emergency departments.
- High-grade fevers may indicate serious underlying pathology.
Purpose of the Study:
- To evaluate the risk of serious illness in children presenting with a rectal temperature greater than 41.1°C (106°F).
- To assess the correlation between initial assessment, laboratory studies, and final diagnosis in these children.
Main Methods:
- Prospective observational study over 9 months in an urban emergency room.
- Inclusion criteria: 15 children with rectal temperature > 41.1°C.
- Data collection included initial assessment, laboratory results, hospital admission, and final diagnosis.
Main Results:
- Eight out of 15 children (53.3%) had serious diagnoses, including bacterial meningitis, bacteremia, pneumonia, pericarditis, and Kawasaki disease.
- Four cases had more severe diagnoses than initially suspected.
- Laboratory studies showed poor correlation with final diagnosis or need for admission.
Conclusions:
- Children with rectal temperatures > 41.1°C are at high risk for severe, potentially life-threatening illnesses.
- Urgent evaluation for sepsis and meningitis is recommended for these children.
- Clinical suspicion should guide management, as initial assessments and lab results may be misleading.
Abstract:
In a 9-month prospective study conducted in an urban emergency room, 15 children with rectal temperature greater than 41.1 degrees C (106 degrees F) were evaluated. Seven of the 15 patients were admitted to the hospital. Two children who were discharged home required subsequent admission, and six were managed on an ambulatory basis. Eight (53.3%) children had serious disease: two bacterial meningitis, two bacteremia without meningitis, two pneumonia, one pericarditis with effusion, and one Kawasaki disease. In four, the final diagnosis indicated a much more serious illness than was considered initially. The laboratory studies did not correlate reliably with the final diagnosis or need for admission. Children with a rectal temperature greater than 41.1 degrees C are at high risk for a life-threatening illness and should be evaluated for sepsis and meningitis.