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Report by Daniel E Lumsden, Specialist Registrar Paediatrics
Checked by Katherine Potier de la Morandière, Consultant in Emergency Medicine
Mayday University Hospital and Manchester Royal Infirmary, UK
A short cut review was carried out to establish whether febrile children with rigors are more likely to have a bacterial infection than febrile children with no rigors. From a search of 494 papers, only one addressed the clinical question. The author, date and country of publication, patient group studied, study type, relevant outcomes, results and study weaknesses of this paper are summarised in table 22.. The clinical bottom line is that the absence of rigors makes it slightly less likely that there will be positive bacterial cultures.
In [febrile children presenting to the emergency department] are [rigors] suggestive of [serious bacterial infection]?
An 18‐month‐old child presents to the emergency department with a temperature of 39°C. The child's temperature falls to 37.2°C following treatment with paracetamol. The child has an inflamed pharynx on examination, and when a history is taken, the child's mother reports that the child has experienced rigors in the last 24 h. There has been no foreign travel. The mother asks if the rigor makes bacterial infection more likely.
Conchrane Library: search term “Rigors”. Medline: search terms “Rigors” OR “Rigor”; limits “All child: 0–18 years” “Humans”. CINAHL: search terms “Rigor AND (Febrile OR Pyrexia)”, 1980 to 2007/02. EMBASE.
Cochrane Library: no relevant papers; Medline, 494 hits, 1 relevant; CINAHL: 1 hit, 0 relevant; EMBASE: 108 hits, same single relevant paper as found on Medline.
Only one paper was found which examined the significance of rigors in febrile children. The children were already judged ill enough to require hospital admission, and so may not be representative of patients presenting directly to the emergency department. The diagnosis of presumed bacterial infection in this paper was made on clinical grounds in some children in the absence of positive cultures. All children had blood, urine and stool cultures. No data are given in the paper in regard to how many children had a lumbar puncture, nor are the results of cerebrospinal fluid cultures given. Lumbar puncture was only performed when felt to be clinically indicated. Throat swabs were not taken.
Children admitted to hospital with a febrile illness but no rigors are less likely to have positive bacterial cultures than those who have rigors. They may, however, still have a clinical diagnosis of bacterial infection.