Predicting prolonged duration of fever in children: a cohort study in primary care.
BACKGROUND
Fever in children in primary care is commonly caused by benign infections, but often worries parents. Information about the duration of fever and its predictors may help in reassuring parents, leading to diminished consultation of health care.


OBJECTIVE
To determine which signs and symptoms predict a prolonged duration of fever in febrile children in primary care and evaluate whether C-reactive protein (CRP) measurement has an additive predictive value for these symptoms.


METHODS
A prospective cohort study at a GPs' cooperative (GPC) out-of-hours service.


METHODS
Children (aged 3 months to 6 years) presenting with fever as stated by the parents were included. Exclusion criteria were no communication in Dutch possible, previous enrolment in the study within 2 weeks, referral to the hospital directly after visiting the GPC, or no informed consent. The main outcome measure was prolonged duration of fever (>3 days) after initial contact.


RESULTS
Four-hundred and eighty children were analysed, and the overall risk of prolonged duration was 13% (63/480). Multivariate analysis combined model of patient history and physical examination showed that 'sore throat' (OR 2.8; 95% CI = 1.30 to 6.01) and 'lymph nodes palpable' (OR 1.87; 95% CI = 1.01 to 3.49) are predictive for prolonged duration of fever. The discriminative value of the model was low (AUC 0.64). CRP had no additive value in the prediction of prolonged duration of fever (OR 1.00; 95% CI = 0.99 to 1.01).


CONCLUSIONS
The derived prediction model indicates that only a few signs and symptoms are related to prolonged duration of fever. CRP has no additional value in this model. Overall, because the discriminative value of the model was low, the duration of fever cannot be accurately predicted.
Department of General Practice, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands.
Gijs
G
Elshout
Department of General Practice, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands.
Marijke
M
Kool
Department of General Practice, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands.
Arthur M
AM
Bohnen
Department of General Practice, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands.
Bart W
BW
Koes
Department of General Pediatrics, Erasmus MC - Sophia Children's Hospital, University Medical Center Rotterdam, Rotterdam, the Netherlands.
Henriëtte A
HA
Moll
Department of General Practice, Erasmus MC, University Medical Center Rotterdam, Rotterdam; Department of General Practice, University Medical Center Groningen, Groningen, the Netherlands.
Marjolein Y
MY
Berger
D000328:Adult; D002097:C-Reactive Protein / Q000032:analysis; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D004505:Education, Nonprofessional / Q000379:methods / Q000458:organization & administration; D005260:Female; D005334:Fever / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology / Q000523:psychology; D006801:Humans; D007223:Infant; D000072281:Lymphadenopathy / Q000150:complications; D008297:Male; D009426:Netherlands / Q000453:epidemiology; D017063:Outcome Assessment, Health Care; D016487:Parenting / Q000523:psychology*; D010612:Pharyngitis / Q000150:complications; D011237:Predictive Value of Tests; D011320:Primary Health Care / Q000379:methods; D011379:Prognosis; D063189:Symptom Assessment; D013997:Time Factors
D002097:C-Reactive Protein
child; child, preschool; family practice; fever; infant; primary care; signs and symptoms