Prospective evaluation of the risk of serious bacterial infection in children who present to the emergency department with hyperpyrexia (temperature of 106°F or higher)

BACKGROUND. Previous studies of children with temperatures > 106 degrees F ( hyperpyrexia) disagree as to whether hyperpyrexia confers a high risk of serious bacterial infection. OBJECTIVES. The purpose of this study was to determine ( 1) the risk of serious bacterial infection in children with hyperpyrexia and ( 2) whether clinical presentation can identify hyperpyrexic patients at risk for serious bacterial infection. METHODS. Data were collected prospectively on all children < 18 years of age presenting to a pediatric emergency department during a 2-year period with rectal temperatures of >= 106 degrees F. History, physical examination, complete blood cell counts, blood cultures, and nasopharyngeal viral cultures were obtained on all of the patients. RESULTS. Of 130 828 visits, 103 children had hyperpyrexia ( 1 per 1270 patient visits). Of the 103 subjects, 20 had serious bacterial infection, and 22 had laboratory-proven viral illness ( including 1 subject with bacterial/viral coinfection). The presence of a chronic underlying illness was associated with an increased risk of serious bacterial infection. The presence of rhinorrhea or any viral symptom was associated with a decreased risk of serious bacterial infection, although diarrhea itself was associated with an increased risk of serious bacterial infection. Age, maximum temperature, and total white blood cell count were not predictive of either bacterial or viral illness. CONCLUSIONS. Children with hyperpyrexia are at equally high risk for serious bacterial infection and for viral illness. Bacterial and viral coinfection also occurs. No aspect of the clinical presentation reliably distinguishes between bacterial and viral illness. We recommend consideration of antibiotic treatment for all children presenting to the emergency department with hyperpyrexia without confirmed viral illness.