FEVER IN GERIATRIC EMERGENCY PATIENTS - CLINICAL-FEATURES ASSOCIATED WITH SERIOUS ILLNESS

Study objective: To determine the clinical significance of fever in ge riatric emergency department patients. Design: Case series with follow -up. Setting: Urban, university-affiliate community hospital. Particip ants: Consecutive patients over the age of 65 years who presented to t he ED during a 12-month period with an oral temperature of 100.0 degre es F (37.8 degrees C) or higher. Results: We considered the following features indicators of serious illness: positive blood culture(s), rel ated death within? month of ED visit, need for surgery or other invasi ve procedure, hospitalization for 4 or more days, IV antibiotics for 3 or more days, and repeat ED visit within 72 hours for related conditi on. Four hundred eighty-nine patients were eligible for study Of the 4 70 patients with complete follow-up data, 357 (76.0%) had indicators o f serious illness. Clinical features found to be independently associa ted with serious illness included oral temperature of 103 degrees F (3 9.4 degrees C) or more, respiration rate of 30 or more, leukocytosis o f 11.0x10(9)/L or more, presence of an infiltrate, and pulse of 120 or more. At least one indicator of serious illness was present in 63 of 128 patients (49.6%) with none of these independently predictive clini cal features. The most common final diagnoses were pneumonia (24.0%), urinary-tract infection (21.7%), and sepsis (12.8%). Conclusion: Fever among geriatric ED patients frequently marks the presence of serious illness. All such patients should be strongly considered for hospital admission, particularly when certain clinical features are present. Th e absence of abnormal findings does not reliably rule out the possibil ity of serious illness.