Abstract
Background
Fever is a common complaint in the pediatric emergency department (ED), but the vast
majority of children evaluated with fever do not have a serious bacterial infection
(SBI). However, in the neonate, a missed SBI can have devastating consequences.
Objectives
To determine the association between various fever characteristics and the risk of
SBI in febrile infants.
Methods
This is a secondary analysis of the Pediatric Emergency Care Applied Research Network
study on febrile infants. Infants with a fever were prospectively enrolled at 26 enrolling
EDs between 2008 and 2013. We analyzed association of height of fever, location of
where temperature was taken (enrolling ED vs. non-health care location), and duration
of fever with SBI.
Results
We included 4821 patients who had at least a blood culture completed. Height of fever
was significantly associated with risk of SBI, with an odds ratio of 1.5 (95% confidence
interval 1.2–1.8). Duration of fever was not associated with risk of SBI, and a fever
taken in the enrolling ED vs. at a non-health care facility was minimally associated
with risk of SBI (odds ratio 1.3, 95% confidence interval 1.0–1.5).
Conclusion
In all analyses, height of fever was associated with all three major types of SBI
in febrile infants. Duration and location of fever were less reliably associated with
risk of SBI, but there was a small association of risk of SBI and a fever taken at
the enrolling ED vs. at a non-health care location.
Keywords
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Article info
Publication history
Published online: August 07, 2019
Accepted:
June 15,
2019
Received in revised form:
June 7,
2019
Received:
March 16,
2019
Footnotes
Preliminary work from this paper was presented at the 2019 American College of Emergency Physicians Conference in October 2018 in San Diego, CA and the 2019 Society for Academic Emergency Medicine Conference in May 2019 in Las Vegas, NV.
Identification
Copyright
© 2019 Elsevier Inc. All rights reserved.
