UMEM Educational Pearls

Category: Pediatrics

Title: Pediatric fever: Is response to antipyretics enough to discharge?

Keywords: Pediatrics, infectious disease, fever, bacteremia (PubMed Search)

Posted: 7/14/2023 by Kathleen Stephanos, MD (Updated: 2/23/2024)
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This study attempts to answer the age old question: What is the importance of fever in pediatric illnesses?

The authors' goal was to assess if response to antipyretics was associated with bacteremia. This article retrospectively reviewed 6,319 febrile children in whom blood cultures were sent and found that 3.8% had bacteremia.  They then looked at the fever curve in response to antipyretics for these two groups in the emergency department over 4 hours. The study concluded that patients with bacteremia have a higher rate of persistent fever despite antipyretics. It is important to note the limitations of this study. As this was retrospective, it is unclear what clinical findings resulted in blood cultures being sent - most febrile children did not have any drawn (23,999 were excluded for this reason). They did not assess other vital signs, and did not address other bacterial infections (UTI, cellulitis, meningitis, otitis media, etc).  Additionally, while patients with bacteremia did have a higher likelihood of fever, the majority of patients in both groups had fever resolution within 4 hours, and both groups had some children with persistent fevers. 

Overall, this does seem to support the decision to consider obtaining further testing in those children with a persistent fever, but also emphasizes the importance of not using fever resolution alone as support for discharge to home or exclusion of bacteremia from the differential. 

References

Baker AH, Monuteaux MC, Michelson KA, Neuman MI. Resolution of Fever in the Pediatric Emergency Department and Bacteremia. Clin Pediatr (Phila). 2023;62(5):474-480.