Fever in kids underestimated by Doctors: new study

By Dr. Ananya Mandal, MDApr 27 2010

In a new study researchers have found that some physicians may be missing the seriousness of an infection in a child presenting with fever.

The study published in the British Medical Journal involved 16,000 children from 2004 to 2006 with fever and found that doctors could not diagnose up to one third of the potentially life-threatening illnesses in these children.

Professor Jonathan Craig from the University of Sydney and Westmead Children's Hospital, who is a lead author of the study, believes that much needs to be done in the diagnosis department in the initial period of a febrile child’s visit to the hospital. “Fever is very common in children, which we knew.

Every year about 50,000 kids present with fever…What we showed was that as expected sometimes children who have serious bacterial illness like urinary tract infection, bacteria in the blood or pneumonia, don't receive antibiotics at the time they present.” He added, “Around Australia, there would be a quarter to half a million a year but the way we diagnose them hasn't progressed or evolved.”

He refuses to call this a failure on the doctor’s part. “I think it represents what happens in everyday clinical practice for every clinical condition, which is that diagnosing someone as soon as they present is very difficult… The fundamental approach to the evaluation of any person with symptoms is to take a comprehensive history and a comprehensive clinical examination and somehow synthesize what is between 40 and 60 items and come up with the most likely diagnosis…. When [doctors] combine them, they tend to underestimate how likely serious bacterial illness is, which is leading to some under-treatment… I don't think that we should scalp the physicians who are working in this setting,” he said.

He also added that this oversight may not be fatal in most cases. “That is true and in our studies there were no fatalities which occurred… As part of the research safeguards we included in the study, we followed up all kids to ensure that either the fever had resolved, their infection had resolved or they had got acute care…. So we have got very good data and also ensured the safety of the kids in the study,” he said.

With so many signs and symptoms Dr. Craig believes it is not difficult to miss out on something and as a consequence underestimate the situation. A new computerized 26-item checklist or algorithm might assist doctors in distinguishing between viral and bacterial infections. The latter cases could then be antibiotics. This could improve the quality of care believes Dr. Craig. “That's what parents want and it's what doctors want,” he signed off.