Temperature Greater Than or Equal to 40 C in Children Less Than 24 Months of Age: A Prospective Study

Abstract

In a prospective study, 330 consecutive children < 24 mo. old coming to the emergency room of Yale-New Haven Hospital [New Haven, Connecticut, USA] with a temperature .gtoreq. 40.degree. C were evaluated. Nearly all patients had a white blood cell (WBC) count, erythrocyte sedimentation rate (ESR) (Wintrobe) blood culture and chest roentgenogram; 88% were evaluated 24-48 h later. The mean WBC count and ESR were significantly elevated in children with positive blood cultures or pneumonia. The risk of bacteremia was increased 3-fold and the risk of pneumonia was increased 2-fold in children with a WBC count .gtoreq. 15,000/mm3 or an ESR .gtoreq. 30 mm/h compared to children without leukocytosis or elevated ESR. In 61% of children with bacteremia or pneumonia, 63% of children in whom these diagnoses were not apparent on physical examination and 86% of children with otitis media complicated by pneumonia or bacteremia a WBC count .gtoreq. 15,000/mm3 or an ESR .gtoreq. 30 mm/h was found. A WBC count .gtoreq. 15,000/mm3 and an ESR .gtoreq. 30 mm/h were more effective than a polymorphonuclear leukocyte count .gtoreq. 10,000/mm3 and/or a band count .gtoreq. 500/mm3 in screening young children with high fever for bacteremia, pneumonia or complicated otitis media.