Abstract
Chills and vomiting have traditionally been associated with severe bacterial infections and bacteremia. However, few modern studies have in a prospective way evaluated the association of these signs with bacteremia, which is the aim of this prospective, multicenter study. Patients presenting to the emergency department with at least one affected vital sign (increased respiratory rate, increased heart rate, altered mental status, decreased blood pressure or decreased oxygen saturation) were included. A total of 479 patients were prospectively enrolled. Blood cultures were obtained from 197 patients. Of the 32 patients with a positive blood culture 11 patients (34%) had experienced shaking chills compared with 23 (14%) of the 165 patients with a negative blood culture, P = 0.009. A logistic regression was fitted to show the estimated odds ratio (OR) for a positive blood culture according to shaking chills. In a univariate model shaking chills had an OR of 3.23 (95% CI 1.35-7.52) and in a multivariate model the OR was 5.9 (95% CI 2.05-17.17) for those without prior antibiotics adjusted for age, sex, and prior antibiotics. The presence of vomiting was also addressed, but neither a univariate nor a multivariate logistic regression showed any association between vomiting and bacteremia. In conclusion, among patients at the emergency department with at least one affected vital sign, shaking chills but not vomiting were associated with bacteremia.
Highlights
Fever and chills are common symptoms in the emergency department
Model 1 is a univariate model which shows an odds ratio (OR) = 3.23 for a positive blood culture according to shaking chills
The presence of shaking chills had a positive predictive value of 36% whereas the presence of vomiting had a positive predictive value of 17%. This prospective multicenter study shows that, in patients with a suspected infection and abnormal vital signs and no previous antibiotics presenting to the Emergency Department, the adjusted OR of shaking chills is approximately six for the presence of bacteremia
Summary
Rapid recognition and initiation of antibiotics are of great importance for survival [10], it is important to rapidly identify patients with bacteremia or a severe bacterial infection. Other investigators have developed clinical prediction rules for the risk of bacteremia in patients with suspected infection [3, 4, 11,12,13,14,15,16,17,18,19,20,21,22,23] Chills and vomiting are two clinical symptoms that are widely considered cardinal symptoms of severe bacterial infections or bloodstream infections, this association and the combination of these symptoms have rarely been systematically studied
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