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Fever of unknown origin: a retrospective review of pediatric patients from an urban, tertiary care center in Washington, DC

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Abstract

Background

Fever of unknown origin (FUO) continues to challenge clinicians to determine an etiology and the need for treatment. This study explored the most common etiologies, characteristics, and average cost of hospitalization for FUO in a pediatric population at an urban, tertiary care hospital in Washington, DC.

Methods

Records from patients admitted to Children’s National Health System between September 2008 and April 2014 with an admission ICD-9 code for fever (780.6) were reviewed. The charts of patients 2–18 years of age with no underlying diagnosis and a temperature greater than 38.3 ºC for 7 days or more at time of hospitalization were included. Final diagnoses, features of admission, and total hospital charges were abstracted.

Results

110 patients qualified for this study. The majority of patients (n = 42, 38.2%) were discharged without a diagnosis. This was followed closely by infection, accounting for 37.2% (n = 41) of patients. Rheumatologic disease was next (n = 16, 14.5%), followed by miscellaneous (n = 6, 5.4%) and oncologic diagnoses (n = 5, 4.5%). The average cost of hospitalization was 40,295 US dollars.

Conclusions

This study aligns with some of the most recent publications which report undiagnosed cases as the most common outcome in patients hospitalized with FUO. Understanding that, often no diagnosis is found may reassure patients, families, and clinicians. The cost associated with hospitalization for FUO may cause clinicians to reconsider inpatient admission for diagnostic work-up of fever, particularly given the evidence demonstrating that many patients are discharged without a diagnosis.

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Authors and Affiliations

  1. Division of Pediatric Rheumatology, Children’s National Health System, Washington, DC, USA

    Ann Marie Szymanski & Tova Ronis

  2. National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, Building 10, Rm 12S251 MSC 1560, 10 Center Drive, Bethesda, MD 20814, USA

    Ann Marie Szymanski

  3. The School of Medicine and Health Sciences, The George Washington University, Washington, DC, USA

    Hugo Clifford

Authors
  1. Ann Marie Szymanski
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  2. Hugo Clifford
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  3. Tova Ronis
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Contributions

AMS conceptualized and designed the study, designed the data collection instruments, collected data, carried out analyses, drafted the initial manuscript, and reviewed and revised the manuscript. HC collected data and reviewed the manuscript. TR conceptualized and designed the study, designed the data collection instruments, and reviewed and revised the manuscript. All authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.

Corresponding author

Correspondence to Ann Marie Szymanski.

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Ethical approval

This study was approved by the Institutional Review Board of Children’s National Health System.

Conflict of interest

No financial or non-financial benefits have been received or will be received from any party related directly or indirectly to the subject of this article.

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Szymanski, A.M., Clifford, H. & Ronis, T. Fever of unknown origin: a retrospective review of pediatric patients from an urban, tertiary care center in Washington, DC. World J Pediatr 16, 177–184 (2020). https://doi.org/10.1007/s12519-019-00237-3

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  • DOI: https://doi.org/10.1007/s12519-019-00237-3

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