Fiebre en Urgencias: detección de patología grave

Abstract

To identify variables associated to severe disease in adult patients with fever in the Emergency Department.Observational, perspective study. Data from all the adult patients with fever (axillary temperature 37.8 degrees C or higher) seen in the medical area of the Emergency Department was collected from January 28th to April 30th of 2006 and included in a logistic regression analysis, the dependent variable being "severe disease". Based on the corresponding risk, a score was assigned to each variable to design a risk of severe disease model.A total of 11271 patients were seen, 786 (7.0%) of whom had fever. Median age was 39 years (37-40), 57% male. Of these, 31% were admitted and 27% had severe disease. Based on the symptoms and signs, upper airways infection was suspected in 309 (39%) and lower airways infection in 130 (17%), abdominal infection in 117 (15%), urinary tract infection in 40 (5%) and no source of infection in 145 (18%). Comorbidity (OR 3.6, 95% CI -1.8-7.2) (4 points), C-reactive protein higher than 10 mg/dl (OR 1.8, 95% CI 1.1-3.7) (2 points) and age (OR 1.02, 95% CI 1.01-1.04) (age older than 60 years 3 points) were associated with severe disease. Fever having a probable upper respiratory origin was a protector factor (OR 0.4, 95% CI 0.2-0.9) (fever from other foci 3 points). Three percent of the patients with less than 3 points had severe disease versus 72% with more than 7 points.Comorbidity, C-reactive protein higher than 10 mg/dl, age and suspicion of source of infection different of upper airways infection were associated to severe disease in adults with fever in the Emergency Department.