Febrile Confusion: Do the Hyperpyrexia Study Conclusions Fit?: In Reply.

Abstract

We appreciate the interest in our study investigating the risk of serious bacterial illness (SBI) in children with hyperpyrexia and the relationship of the clinical presentation in defining those patients at risk.1 Gunasekera et al question the conclusion that “children with hyperpyrexia are at equally high risk for serious bacterial infection and for viral illness” on the basis of a concern that 62 of 103 children may have been ignored or distributed equally into the bacterial and viral groups. They contend that these children are more likely to have clinical courses consistent with viral illness. It is important to note that our intention was to evaluate the risk of SBI using hard end points (specifically, positive cultures). Therefore, our statistical analysis took into account only those patients for whom cultures were positive. No sensitivity analysis was offered for those patients for whom cultures were negative. We agree that cultures are often negative in children with viral …