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.
Date First Published:
June 20, 2006
Last Updated:
July 19, 2006
Report by:
Claire Ives, Medical Student (Manchester Royal Infirmary)
Search checked by:
Claire Ives, Manchester Royal Infirmary
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>
EMBASE <1980 to 2006 week 26>
CINAHL <1982 to June week 5 2006>
Search Details:
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)" )
([ (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)" )
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.
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):
| Study Title | Patient Group | Study type (level of evidence) | Outcomes | Key results | Study Weaknesses |
|---|---|---|---|---|---|
| Association of temperature Greater Than 41°c (106°F) With Serious Illness. Press, S. & Fawcett, 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 |
| Predicting serious bacterial infection in young children with a fever without source. Bleeker, S.E. Moons, K.G.M. Derksen-Lubsen, G. Grobbee, D.E. & 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. |
Author Commentary:
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
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.
- 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.