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International Journal of Emergency Medicine

, 4:57

First Online: 05 September 2011Received: 05 May 2011Accepted: 05 September 2011

Abstract

BackgroundFever is a common presenting complaint in the developing world, but there is a paucity of literature to guide investigation and treatment of the adult patient presenting with fever and no localizing symptoms.

ObjectiveThe objective of this study was to devise a standardized protocol for the evaluation and treatment of febrile adult patients who have no localizing symptoms in order to reduce unnecessary testing and inappropriate antimicrobial use. After devising the protocol, a pilot study was performed to assess its feasibility in the emergency department.

MethodsA protocol was formulated for adult patients presenting with fever who had no clinical evidence of sepsis and no localizing symptoms to suggest the etiology of their fever. Investigations were based on duration of fever with no investigations indicated prior to day 3. Treatment was guided by results of investigations. A pilot study was performed after protocol implementation, wherein data were collected on successive adult patients presenting with fever.

ResultsDuring the 6-week study period, 342 patients presented with fever, 209 of whom fit the parameters of the protocol, with 113 of these patients presenting on the 1st or 2nd day of fever. All patients experienced defervescence of fever, with ten patients being lost to follow-up. Of the patients presenting on day 1 or 2 of fever, 75.2% 85-113 defervesced without the need for testing; 53.1% 60-113 experienced defervescence without the need for antimicrobial therapy.

ConclusionImplementation of this rational, standardized protocol for the assessment and treatment of stable adult patients presenting with acute undifferentiated febrile illness can lead to reduced rates of testing and antimicrobial use. A prospective, controlled trial will be required to confirm these findings and to assess additional safety outcome measures.

List of abbreviationsEDEmergency department

SMFSundaram Medical Foundation, Chennai, Tamil Nadu, India

AUFIacute undifferentiated febrile illness

IRBinstitutional review board.

Electronic supplementary materialThe online version of this article doi:10.1186-1865-1380-4-57 contains supplementary material, which is available to authorized users.

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Autor: Sudhagar Thangarasu - Piruthiviraj Natarajan - Parivalavan Rajavelu - Arjun Rajagopalan - Jeremy S Seelinger Devey

Fuente: https://link.springer.com/article/10.1186/1865-1380-4-57







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