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@article{Nijman:2023:10.1136/archdischild-2023-325343,
author = {Nijman, RG and Tan, CD and Hagedoorn, NN and Nieboer, D and Herberg, JA and Balode, A and von, Both U and Carrol, ED and Eleftheriou, I and Emonts, M and van, der Flier M and de, Groot R and Kohlmaier, B and Lim, E and Martinón-Torres, F and Pokorn, M and Strle, F and Tsolia, M and Yeung, S and Zachariasse, JM and Zavadska, D and Zenz, W and Levin, M and Vermont, CL and Moll, HA and Maconochie, IK and PERFORM, consortium},
doi = {10.1136/archdischild-2023-325343},
journal = {Archives of Disease in Childhood},
pages = {632--639},
title = {Are children with prolonged fever at a higher risk for serious illness? A prospective observational study},
url = {http://dx.doi.org/10.1136/archdischild-2023-325343},
volume = {108},
year = {2023}
}

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TY  - JOUR
AB  - 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.
AU  - Nijman,RG
AU  - Tan,CD
AU  - Hagedoorn,NN
AU  - Nieboer,D
AU  - Herberg,JA
AU  - Balode,A
AU  - von,Both U
AU  - Carrol,ED
AU  - Eleftheriou,I
AU  - Emonts,M
AU  - van,der Flier M
AU  - de,Groot R
AU  - Kohlmaier,B
AU  - Lim,E
AU  - Martinón-Torres,F
AU  - Pokorn,M
AU  - Strle,F
AU  - Tsolia,M
AU  - Yeung,S
AU  - Zachariasse,JM
AU  - Zavadska,D
AU  - Zenz,W
AU  - Levin,M
AU  - Vermont,CL
AU  - Moll,HA
AU  - Maconochie,IK
AU  - PERFORM,consortium
DO  - 10.1136/archdischild-2023-325343
EP  - 639
PY  - 2023///
SN  - 0003-9888
SP  - 632
TI  - Are children with prolonged fever at a higher risk for serious illness? A prospective observational study
T2  - Archives of Disease in Childhood
UR  - http://dx.doi.org/10.1136/archdischild-2023-325343
UR  - https://www.ncbi.nlm.nih.gov/pubmed/37185174
UR  - https://adc.bmj.com/content/108/8/632
UR  - http://hdl.handle.net/10044/1/106163
VL  - 108
ER  -

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