Short-Term Outcomes of Pediatric Emergency Department Febrile Illnesses

Abstract

To describe short-term outcomes relevant to children and their caregivers after evaluation in the emergency department (ED) for febrile illnesses. This was a prospective cohort study of children aged 28 days to 18 years presenting with fever (> or =38 degrees C), or chief complaint of fever, who were evaluated and discharged to home from tertiary care pediatric ED. Enrollment occurred on randomly selected study days over 1 year. Caregivers were then contacted via telephone after 7 to 10 days to assess outcomes, including days of fever, child and family activity impairments, as well as return to health care. Follow-up was complete for 322 (72%) of 451 enrolled subjects. Mean age of subjects was 31.5 months. The most common discharge diagnosis was undifferentiated febrile illness (20.5%). Mean total duration of fever was 4.41 days (95% confidence interval [CI], 4.14-4.81); 38.9% remained febrile for 5 days or longer. For children, impairments in each outcome (activity, oral intake, sleep, behavior) persisted longer than 2.5 days; over 14% of them remained impaired at follow-up in each outcome. Children missed a mean of 2.63 days of day care or school (95% CI, 2.21-3.06); 37.4% missed 3 days or longer. Primary caregivers missed 1.47 days of work or school (95% CI, 1.19-1.75); 10.5% missed 5 days or longer. After ED evaluation, 23.7% made a nonscheduled revisit to the primary medical doctor or ED. Children, and their caregivers, experience prolonged fever and impairments in activities, and frequently relapse to health care as a result of febrile illnesses. Often considered minor in nature, febrile illnesses have considerable effects on the child, caregivers, and families after ED evaluation.