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

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Nijman, Ruud G, Tan, Chantal D, Hagedoorn, Nienke N, Nieboer, Daan, Herberg, Jethro Adam, Balode, Anda, von Both, Ulrich, Carrol, Enitan D ORCID: 0000-0001-8357-7726, Eleftheriou, Irini, Emonts, Marieke et al (show 16 more authors) , van der Flier, Michiel, de Groot, Ronald, Kohlmaier, Benno, Lim, Emma, Martinon-Torres, Federico, Pokorn, Marko, Strle, Franc, Tsolia, Maria, Yeung, Shunmay, Zachariasse, Joany M, Zavadska, Dace, Zenz, Werner, Levin, Michael, Vermont, Clementien L, Moll, Henriette A and Maconochie, Ian K (2023) Are children with prolonged fever at a higher risk for serious illness? A prospective observational study ARCHIVES OF DISEASE IN CHILDHOOD, 108 (8). pp. 632-639. ISSN 0003-9888, 1468-2044

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Abstract

Objectives To describe the characteristics and clinical outcomes of children with fever ≥5 days presenting to emergency departments (EDs). Design: Prospective observational study. Setting 12 European EDs. Patients Consecutive febrile children <18 years between January 2017 and April 2018. Interventions Children with fever ≥5 days and their risks for serious bacterial infection (SBI) were compared with children with fever <5 days, including diagnostic accuracy of non-specific symptoms, warning signs and C-reactive protein (CRP; mg/L). Main outcome measures SBI and other non-infectious serious illness. Results: 3778/35 705 (10.6%) of febrile children had fever ≥5 days. Incidence of SBI in children with fever ≥5 days was higher than in those with fever <5 days (8.4% vs 5.7%). Triage urgency, life-saving interventions and intensive care admissions were similar for fever ≥5 days and <5 days. Several warning signs had good rule in value for SBI with specificities >0.90, but were observed infrequently (range: 0.4%-17%). Absence of warning signs was not sufficiently reliable to rule out SBI (sensitivity 0.92 (95% CI 0.87-0.95), negative likelihood ratio (LR) 0.34 (0.22-0.54)). CRP <20 mg/L was useful for ruling out SBI (negative LR 0.16 (0.11-0.24)). There were 66 cases (1.7%) of non-infectious serious illnesses, including 21 cases of Kawasaki disease (0.6%), 28 inflammatory conditions (0.7%) and 4 malignancies. Conclusion: Children with prolonged fever have a higher risk of SBI, warranting a careful clinical assessment and diagnostic workup. Warning signs of SBI occurred infrequently but, if present, increased the likelihood of SBI. Although rare, clinicians should consider important non-infectious causes of prolonged fever.

Item Type:	Article
Uncontrolled Keywords:	Child Health, Emergency Care, Epidemiology, Infectious Disease Medicine, Paediatric Emergency Medicine
Divisions:	Faculty of Health & Life Sciences Faculty of Health & Life Sciences > Inst. Infection, Vet & Ecological Sciences
Depositing User:	Symplectic Admin
Date Deposited:	14 Jun 2023 08:55
Last Modified:	24 Jan 2026 04:14
DOI:	10.1136/archdischild-2023-325343
Related Websites:	Author Publisher
URI:	https://livrepository.liverpool.ac.uk/id/eprint/3170929
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