Does a high temperature >39°c indicate that a child will be more likely to have meningitis or other serious bacterial infections than a child with a temperature <39°c.

Report By: Claire Ives - Medical Student
Search checked by Claire Ives - Medical Student
Institution: Manchester Royal Infirmary
Date Submitted: 20th June 2006
Last Modified: 19th July 2006
Status: Blue (submitted but not checked)

Three Part Question

In [a febrile child with a high temperature >39°c] is this good indicator] for [meningitis or other serious bacterial infections]

Clinical Scenario

A mother rushes her 20 month child into A and E with a temperature of 40°c. The child is lethargic and making little eye contact. The fact that the child's temperature is so high raises cause for concern that the child could have meningitis.

Search Strategy

OVID Medline <1966-June Week 3 2006>
EMBASE <1980 to 2006 week 26>
CINAHL <1982 to June week 5 2006>
Paediatric filter applied and diagnostic filter specificity
([ (high adj temp).mp. OR (high adj fever).mp. or exp Fever/ OR febrile.mp. OR temperature.mp. OR exp Tempaerature/ OR exp Body Temperature/ or exp Skin Temperature/ OR hot.mp.] AND (indicat$.mp. OR signify$.mp. OR measue$.mp. OR predict$.mp.) AND (exp Disease/ OR exp Infection/ OR infection.mp. OR illness.mp. OR bacterial infection.mp. OR exp Bacterial Infections/ OR viral infection.mp.) Limit to (humans and English language and randomized controlled trial and "diagnosis (specificity)" )

Search Outcome

Medline: 3 papers found
EMBASE: 170 papers found
CINAHL: 255 papers found
Cochrane: 0 relevant papers found
2 relevant papers found 1 from Medline and 1 from references of article.

Relevant Paper(s)

Author, date and country	Patient group	Study type (level of evidence)	Outcomes	Key results	Study Weaknesses
Press, S. Fawcet, N.P. 1985 USA	15 children who presented to urban emergency room with a rectal temp > 41°c 14 pts between 6 and 39 months 1 pt 6 days of age	Prospective study	8 children had serious disease: 2 bacterial meningitis, 2 bacteraemia without meningitis, 1 pericarditis, 1 pneumonia, 1 Kawasaki.	53.3% children had serious disease with a temperature > 41.1°c.	Very small sample size. No inclusion/ exclusion criteria mentioned
Bleeker, S.E. Moons, K.G.M. Derksen-Lubsen, G. Grobbee, D.E. and Moll H.A. 2001 Rotterdam	231 children who attended paediatric emergency department due to fever without source.	Retrospective cohort	Temp <36.7 °c or greater than/equal to 40°c at examination univariately associated with serious bacterial infection at p<0.15.	Classed as an independent predictor of presence/absence of serious bacterial infection.	Patients that were not referred by a GP and also patients from other hospitals were excluded. Patients evaluated in this study were <39 months of age although it did say the centre saw children up to 15 years of age-was it a large coincidence they were not included in the study or were they excluded for some reason.

Comment(s)

All children have their own normal temperatures. The clinical presentation of the child with a fever should play a large part in determining the clinical diagnosis and relevant intervention. No single tool has yet been shown to have 100% diagnostic specificty and sensitivity in diagnosing serious bacterial infections. More studies of a larger size are needed to provide us with a diagnostic screening tool for serious bacterial infection. This would help rule out unnecessary investigations and stop practitioners missing necessary potentially serious cases

Clinical Bottom Line

Children with a fever higher than 41.1°c constitute a group at high risk for serious disease such as meningitis.

References

Press, S. & Fawcett, N.P. Association of temperature Greater Than 41°c (106°F) With Serious Illness. Clinical Pediatrics. Vol 24(1), Jan 1985, p21-25
Bleeker, S.E. Moons, K.G.M. Derksen-Lubsen, G. Grobbee, D.E. & Moll, H.A. Predicting serious bacterial infection in young children with a fever without source. Acta Paediatr. Vol 90 2001, p1226-1232.