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Body temperature not an accurate indicator of serious bacterial infection
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The accuracy of an infant’s temperature measured at presentation at the emergency department is not a reliable indicator for severe bacterial infection, according to a recent study.
“Temperature is an inaccurate marker of serious bacterial infection in children presenting to the emergency department with fever and reliance on magnitude of fever to guide further evaluation will result in misclassification of both serious bacterial infections and self-limiting illnesses,” Sukanya De, MBBS, MD, PhD, of the University of Sydney, Australia, and colleagues wrote. “Low grade fever does not rule out serious bacterial infection at any age. Although high fever warrants careful evaluation, it does not per se rule in serious bacterial infection.”
The researchers conducted a study of 15,781 cases of children (aged 0-5 years) presented to the emergency department with a fever. Data was input into a febrile child assessment electronic records system that captured initial temperature at presentation, temperature taken by a physician, the physician’s impression of the child’s appearance, duration of the illness and any relevant background medical information.
Of the 15,702 children with a temperature above 39° C, 1,106 had a fever due to a severe bacterial infection. The average temperature captured was 38° C, which indicated a low-grade fever.
Based on these findings, the researchers estimate that setting a threshold of 38° C will still miss one-third of the children with serious bacterial infection. Furthermore, only one in six children with a fever of more than 40° C will have a serious bacterial infection.
The researchers noted that temperature testing increased in reliability when factoring in age, with children in the cohort aged less than 6 months more likely to have a serious bacterial infection when registering a fever higher than 39° C. Duration of illness also slightly increased the likelihood of temperature accurately indicating a bacterial infection. However, a physician’s impression of the child’s state did not improve the accuracy of temperature testing.
“Body temperature at presentation is not an accurate marker of serious bacterial infections in young febrile children presenting to emergency department. Clinicians… must take other relevant clinical parameters into consideration, including age and duration of illness,” De and colleagues wrote. – by David Costill
Disclosure: The researchers report no relevant financial disclosures.
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