Abstract
The occurrence of fever and the clinical profile of febrile patients on the medical service of a teaching hospital were studied prospectively. Thirty-six per cent of 972 patients developed fever (temperature exceeding 38°C). Their 13% mortality rate and 13.2-day average hospital stay exceeded the 3% mortality and seven-day hospitalization for afebrile patients (p<0.0001 for both). Most fever episodes occurred during the first two hospital days. Approximately 30% of first and subsequent fever episodes were caused by bacterial infections; illnesses involving tissue necrosis (e.g., stroke, myocardial infarction) accounted for 20%. Five conditions comprised 53% of diagnoses: respiratory and urinary tract infections, neoplasm, myocardial infarction, and drug reaction. Only one patient had a fever of uncertain origin. Several clinical clues used frequently to identify bacterial infections were reevaluated. Patients with bacterial infections had higher temperatures on the first febrile day (mean 38.9°C) and were more likely to have had prior infections than those with other causes of fever (mean 38.3°C, p<0.001). Older patients (>75 years) had a lower febrile response to bacterial infections than younger patients. Fever in hospitalized medical patients is a common and important concomitant of increased mortality and length of hospitalization.
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Supported in part by grants from the National Center for Health Services Research (HS 02063 and HS 04066) and by a grant from the Henry J. Kaiser Family Foundation. The work was performed, in part, while Dr. Bor was a Henry J. Kaiser Fellow in General Medicine, Harvard Medical School.
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Bor, D.H., Makadon, H.J., Friedland, G. et al. Fever in hospitalized medical patients. J Gen Intern Med 3, 119–125 (1988). https://doi.org/10.1007/BF02596115
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DOI: https://doi.org/10.1007/BF02596115