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

ObjectivesTo describe the characteristics and clinical outcomes of children with fever >= 5 days presenting to emergency departments (EDs). DesignProspective observational study. Setting12 European EDs. PatientsConsecutive febrile children InterventionsChildren 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 measuresSBI and other non-infectious serious illness. Results3778/35 705 (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 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. ConclusionChildren 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.