Predictors of serious bacterial infection in children aged 3 to 36 months with fever without source

Goh PL, Lee SW, Wong EH
Correspondence: Dr. Goh Pak Liang, pak_liang_goh@cgh.com.sg

ABSTRACT
Introduction Children commonly present with fever without source yet there is no reliable and consistent method of identifying those at risk of serious bacterial infection. In this study, we sought to identify predictors of serious bacterial infection in children aged between three to 36 months with fever without source.
Methods Inpatient records of all children aged three to 36 months admitted from the Emergency Department of Singapore's main paediatric hospital between October 2001 to February 2002 with International Classification of Diseases (ninth revision) diagnosis codes 038 (septicaemia), 079 (viral fever), or 780 (pyrexia of unknown origin), were retrieved and reviewed. Patients identified as having fever without source were enrolled.
Results Of 86 enrolled children, 17 (19.8 percent) had serious bacterial infection. Duration of fever and white blood cell count were found to be significant predictors. Children with white blood cell count equal to or greater than 16,000/cubic mm had 6.9 times (95 percent confidence interval [CI] is 1.7 to 28.4) increased risk of serious bacterial infection, while children with fever of duration exceeding three days before presentation had 3.8 times (95 percent CI is 1.1 to 13.1) increased risk of serious bacterial infection. A combination of white blood cell count less than 16,000/cubic mm and duration of fever three days or less had a negative predictive value of 1.0 (95 percent CI is 0.88 to 1.0) and a sensitivity of 1.0 (95 percent CI is 0.82 to 1.0).
Conclusion The two identified predictors offer an estimate of the risk of serious bacterial infection in children aged three to 36 months with fever without source.

Keywords: bacteraemia, children, fever of unknown diagnosis, fever without source, white blood cells
Singapore Med J 2006; 47(4): 276-280