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

Lookup NU author(s): Dr Christopher Richards, Dr David WalshawORCiD, Professor Andrew Cant


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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. © 2001 The British Infection Society.

Publication metadata

Author(s): Richards CGM; Walshaw D; Cant AJ; Nademi Z; Clark J

Publication type: Article

Publication status: Published

Journal: Journal of Infection

Year: 2001

Volume: 43

Issue: 4

Pages: 221-225

ISSN (print): 0163-4453

ISSN (electronic): 1532-2742

Publisher: WB Saunders Co. Ltd


DOI: 10.1053/jinf.2001.0920

PubMed id: 11869058


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