title: Practice guidelines for evaluating new fever in critically ill adult patients. Task Force of the Society of Critical Care Medicine and the Infectious Diseases Society of America.
abstract: OBJECTIVE
  The development of practice guidelines for evaluating adult patients who develop new fever in the intensive care unit (ICU) for the purpose of guiding clinical practice.
  
  
  METHODS
  A task force of 13 experts in disciplines related to critical care medicine, infectious diseases, and surgery was convened from the membership of the Society of Critical Care Medicine and the Infectious Disease Society of America.
  
  
  METHODS
  The task force members provided personal experience and determined the published literature (articles retrieved with use of MEDLINE or textbooks) from which consensus would be sought. The published literature was reviewed and classified into one of four categories, according to study design and scientific value.
  
  
  METHODS
  The task force met several times in person and twice monthly by teleconference over a 1-year period to identify the pertinent literature and arrive at consensus recommendations. Consideration was given to the relationship between the weight of scientific evidence and the experts' opinions. Draft documents were composed and debated by the task force until consensus was reached by nominal group process.
  
  
  CONCLUSIONS
  The panel concluded that because fever can have many infectious and noninfectious etiologies, a new fever in an adult patient in the ICU should trigger a careful clinical assessment rather than automatic orders for laboratory and radiological tests. A cost-conscious approach to obtaining diagnostic studies should be undertaken if they are indicated after a clinical evaluation. The goal of such an approach is to determine, in a directed manner, whether infection is present so that additional testing can be avoided and therapeutic options can be identified.
authors.affiliation: National Institutes of Health, Bethesda, Maryland 20892, USA.
authors.forename: N P
authors.initials: NP
authors.lastname: O'Grady
authors.forename: P S
authors.initials: PS
authors.lastname: Barie
authors.forename: J G
authors.initials: JG
authors.lastname: Bartlett
authors.forename: T
authors.initials: T
authors.lastname: Bleck
authors.forename: G
authors.initials: G
authors.lastname: Garvey
authors.forename: J
authors.initials: J
authors.lastname: Jacobi
authors.forename: P
authors.initials: P
authors.lastname: Linden
authors.forename: D G
authors.initials: DG
authors.lastname: Maki
authors.forename: M
authors.initials: M
authors.lastname: Nam
authors.forename: W
authors.initials: W
authors.lastname: Pasculle
authors.forename: M D
authors.initials: MD
authors.lastname: Pasquale
authors.forename: D L
authors.initials: DL
authors.lastname: Tribett
authors.forename: H
authors.initials: H
authors.lastname: Masur
mesh_terms: D000328:Adult; D001800:Blood Specimen Collection; D001831:Body Temperature; D002408:Catheters, Indwelling / Q000009:adverse effects; D003362:Cost-Benefit Analysis; D003422:Critical Care; D016638:Critical Illness; D019468:Disease Management; D005334:Fever / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D006801:Humans; D007239:Infections / Q000175:diagnosis*; D007249:Inflammation / Q000175:diagnosis; D007362:Intensive Care Units; D008828:Microbiological Techniques