Some doctors may not be taking into account the seriousness of an infection if a child has a fever, according to a report published in the British Medical Journal (BMJ) this week. The study found that possibly 30% of potentially life-threatening illnesses in children with fever were not being diagnosed.

Professor Jonathan Craig, University of Sydney and Westmead Children’s Hospital, and team wanted to evaluate current processes by which young children presenting with fever, but suspected of having serious bacterial infection are diagnosed and treated. They also aimed to develop and test a multivariable model to distinguish serious bacterial infections from self limiting non-bacterial illnesses.

The two year prospective cohort study involved 16,000 children under 5 years of age, at the emergency department of The Children’s Hospital at Westmead, Westmead, Australia from 2004 to 2006, who presented with fever.

Professor Craig said “Fever is very common in children, which we knew. Every year about 50,000 kids present with fever. What we showed was that as expected sometimes children who have serious bacterial illness like urinary tract infection, bacteria in the blood or pneumonia, don’t receive antibiotics at the time they present. Around Australia, there would be a quarter to half a million a year but the way we diagnose them hasn’t progressed or evolved.”

The report concluded that emergency department doctors tend to underestimate the probability of serious bacterial infection in young children with fever. This leads to undertreatment with antibiotics.

The authors added that a clinical diagnostic model could improve decision-making by increasing sensitivity for identifying serious bacterial infection, thus improving prompt treatment.

Professor Craig said that in everyday clinical practice, diagnosing somebody as soon as they present is not always easy. “The fundamental approach to the evaluation of any person with symptoms is to take a comprehensive history and a comprehensive clinical examination and somehow synthesize what is between 40 and 60 items and come up with the most likely diagnosis.” When doctors combine them all they tend to underestimate the probability of bacterial infection, which is leading to some undertreatment.

Craig added that in the vast majority of cases this oversight was not fatal. In all cases in this study all the children were followed up to make sure that either the fever had gone away, the infection had resolved, or they received proper and effective care.

“The accuracy of clinical symptoms and signs for the diagnosis of serious bacterial infection in young febrile children: prospective cohort study of 15 781 febrile illnesses”
Jonathan C Craig, Gabrielle J Williams, Mike Jones, Miriam Codarini, PhD, Petra Macaskill, Andrew Hayen, Les Irwig, Dominic A Fitzgerald, David Isaacs, Mary McCaskill
British Medical Journal (BMJ) Published 20 April 2010, doi:10.1136/bmj.c1594

Written by Christian Nordqvist