The causes of fever in children attending hospital in the North of England

Nademi, Z., Clark, J., Richards, C. G. M., Walshaw, D. and Cant, A. J. (2001) The causes of fever in children attending hospital in the North of England. Journal of Infection, 43 4: 221-225. doi:10.1053/jinf.2001.0920

Author Nademi, Z.
Clark, J.
Richards, C. G. M.
Walshaw, D.
Cant, A. J.
Title The causes of fever in children attending hospital in the North of England
Journal name Journal of Infection   Check publisher's open access policy
ISSN 0163-4453
Publication date 2001-11-01
Sub-type Article (original research)
DOI 10.1053/jinf.2001.0920
Open Access Status Not yet assessed
Volume 43
Issue 4
Start page 221
End page 225
Total pages 5
Place of publication London, United Kingdom
Publisher W.B. Saunders
Language eng
Formatted abstract
Objectives: Fever is a common symptom in children presenting to casualty. Identifying the seriously ill is difficult. Previous studies, mainly from North America, suggest that symptoms, signs and simple investigations may help to do this. The aim of the present study was to assess the causes of fever and identify clinical and laboratory features suggesting serious disease in U.K. children presenting to hospital with temperatures ≥ 38°C.

Methods: All children with a temperature of ≥38°C seen in two hospitals between August and October 1999.

Results: One hundred and forty one children between 8 days and 16 years of age were studied, 64% male, 55% aged under 2 years. Eighty three percent had temperatures between 38 and 39°C. Ninety six percent were casualty or GP referrals and 4% were tertiary referrals. Twenty nine percent (41/141) had serious disease but microbiologically or radiologically proven in only 22% (31/141); pneumonia (nine), meningitis (seven), sepsis (five), urinary tract infection (five), brain abscess (two), toxic shock syndrome (one), appendicitis (one), ischiorectal abscess (one). Forty two percent (5/12) of microbiologically proven meningitis and sepsis and 36% (8/22) of all meningitis and sepsis were meningococcal. Seventy one percent had non-serious diseases. In cases of serious disease the temperature was > 39°C in 15% (sensitivity: 14%, specificity: 82%, PPV: 25%). Poor feeding and restlessness predicted serious disease with a sensitivity of 78% and 76%, respectively. Full blood count (FBC) was taken in 50% of patients on admission; in 44% of serious and 24% of non-serious diseases WBC was between 5000 and 15 000/mm3 and WBC ≥15 000/mm3 was seen in 39% of serious diseases (sensitivity: 10%, specificity: 95%, PPV: 44%).

Conclusions: One out of three of children referred with fever had a serious disease. Degree of temperature and WBC count were poor predictors of serious disease. Interestingly, poor feeding and restlessness were more sensitive predictors, suggesting high fever and WBC count can not replace clinical assessment of the child with a temperature.
Q-Index Code C1
Q-Index Status Provisional Code
Institutional Status Non-UQ

Document type: Journal Article
Sub-type: Article (original research)
Collection: School of Medicine Publications
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Citation counts: TR Web of Science Citation Count  Cited 15 times in Thomson Reuters Web of Science Article | Citations
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