Predictive value of chills in patients presenting with fever to urgent care department

Objective. To ascertain the correlation between chills, bacteraemia, infection type and clinical progress in patients presenting with fever to the casualty department. Design. Prospective, descriptive. Method. Anamnestic,clinical and microbiological data were registered from patients with fever (> 38.2°C rectal) presenting to the Casualty Department of the Leiden University Hospital and the Bronovo Hospital, in the period I February 1994-31 July 1995 respectively i February 1996-31 July 1997. Results. A total of 764 patients (424 men and 340 women; median age: 66 years) were included in the study. A chill was reported by 270 patients (35%) Bacteria were isolated from the blood culture in the case of 141 patients (18%). The relative risk (RR) for bacteraemia in the case of a chill was 2.8 (95% CI: 2.1-3.8); the positive predictive value of a chill for bacteraemia was 31% and the negative predictive value 89%. For 683 (89%) of the 764 patients the cause of the fever was probably or certainly an infection, which was mostly pulmonary (319 patients; 42%) or urogenital (112 patients; 15%) in origin. The positive predictive value was 24% for patients with respiratory tract infections and 48% for patients with urinary tract infections. Mortality occurred in the case of 62 patients (8%) after a median admission period of II days. The patients who died were older than the patients discharged (p <0.01) and there was a statistically significant correlation between mortality with bacteraemia (RR: 1.1) and serious comorbidity (RR: 6.1). Conclusion. There was a strong correlation between the chill indicated in the anamnesis and bacteraemia, especially in patients with a urinary tract infection. Bacteraemia, advanced age and serious comorbidity were unfavourable prognostic factors.