DURATION OF FEVER AND ITS RELATIONSHIP TO BACTEREMIA IN FEBRILE OUTPATIENTS 3 TO 36 MONTHS OLD

Objective: To determine the relationship between the duration of fever as reported by caregivers and the likelihood of occult bacteremia in highly febrile young children, Methods: This is a prospective cohort s tudy performed as part of a prior, multicenter, randomized, interventi onal trial of oral versus intramuscular antibiotics in the prevention of complications of occult bacteremia in febrile children presenting t o nine urban pediatric emergency departments at eight medical centers, Participants included children three to 36 months of age with a tempe rature of greater than or equal to 39.0 degrees C and a nonfocal illne ss (or uncomplicated otitis media) managed as outpatients, The outcome measure was the presence of bacteremia, Results: Of the 6680 randomiz ed patients, 6619 (99.1%) had a culture of their blood and a valid rep orted duration of fever, The median duration of fever in patients with bacteremia (n = 192) and without bacteremia (n = 6427) was the same, one to two days, but the mean rank of patients with bacteremia was sig nificantly lower than that of patients without bacteremia (P = 0.0009) , A significantly greater proportion of patients with fever < 1 day ha d bacteremia than patients with fever greater than or equal to 1 day ( P = 0.004), and a significantly greater proportion of patients with fe ver < 2 days had bacteremia than patients with fever greater than or e qual to 2 days (P = 0.009), The sensitivity, specificity, positive pre dictive value, and negative predictive value of fever < 1 day in detec ting occult bacteremia were 40.1, 69.8, 3.8, and 97.5%, respectively. Conclusion: Children with occult bacteremia have significantly shorter durations of fever than patients without bacteremia, but this differe nce is small and not clinically useful.