Fever in Adults
Cardinal Presentations / Presenting Problems, Infections, Inflammatory
First 5 Minutes
Infectious:
- Sepsis[1] [2]
- Pneumonia with respiratory failure
- Meningitis
- Cavernous sinus thrombosis
- Necrotizing fasciitis
Non-infectious:
- Pulmonary Embolism (PE)[3]
- Febrile patient with respiratory complaints.
- Pulmonary Embolism – Diagnosis : Emergency Care BC
- Pulmonary Embolism – Treatment : Emergency Care BC
- Myocardial Infarction
- Hyperthermia (hyperpyrexia) (Temp > 41.0°C or > 105.8°F) – Typically not infectious and does not respond to anti-pyretics [4].
- Heat exposure / heat stroke – Exertional Heat Illness : Emergency Care BC
- Neuroleptic malignant syndrome – Neuroleptic Malignant Syndrome (Diagnosis & Treatment) : Emergency Care BC
- Serotonin syndrome
- Intracranial hemorrhage – Subarachnoid Hemorrhage – Diagnosis : Emergency Care BC & Increased ICP : Emergency Care BC
- Thyroid storm – Thyroid Storm – Diagnosis and Treatment : Emergency Care BC
- Anticholinergic toxidrome (tricyclic antidepressants) – Common Toxidromes – Diagnosis & Treatment : Emergency Care BC
- Sympathomimetic toxidrome (amphetamines, cocaine)
Diagnostic Process
Quality Of Evidence?
High
We are highly confident that the true effect lies close to that of the estimate of the effect. There is a wide range of studies included in the analyses with no major limitations, there is little variation between studies, and the summary estimate has a narrow confidence interval.
Moderate
We consider that the true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different. There are only a few studies and some have limitations but not major flaws, there are some variations between studies, or the confidence interval of the summary estimate is wide.
Low
When the true effect may be substantially different from the estimate of the effect. The studies have major flaws, there is important variations between studies, of the confidence interval of the summary estimate is very wide.
Justification
Fever presentation yields an expansive differential diagnosis. This PECS identifies some of the critical and common presentations, while providing a differential diagnosis intended to be useful in an emergency department setting.
Related Information
OTHER RELEVANT INFORMATION
Reference List
N. BC Sepsis, “Adult ED Sepsis Guidelines Algorithm (2022),” 2022. [Online]. Available: https://healthqualitybc.ca/resources/2022-emergency-department-sepsis-guidelines-as-an-algorithm/#details.
N. BC Sepsis, “2022 Emergency Department Sepsis Guidelines,” 2022. [Online]. Available: https://healthqualitybc.ca/wp-content/uploads/2022-Emergency-Department-Guidelines-FINAL_Sept-2023.pdf.
H. Murray, G. Ellis, D. Blumenthal and T. Sos, “Fever and pulmonary thromboembolism,” The American Journal of Medicine, vol. 67, no. 2, pp. 232-235, August 1979.
S. DeWitt, S. A. Chavez, J. Perkins, B. Long and A. Koyfman, “Evaluation of fever in the emergency department,” American Journal of Emergency Medicine, vol. 35, no. 11, pp. 1755 – 1758, 2017.
S. Balli, K. R. Shumway and S. Sharan, Physiology, Fever, Treasure Island, Florida: StatPearls [Internet], 2023.
I. Brown and N. Finnigan, Fever of Unknown Origin, Treasure Island, Florida: StatPearls [Internet], 2023.
RESOURCE AUTHOR(S)
DISCLAIMER
The purpose of this document is to provide health care professionals with key facts and recommendations for the diagnosis and treatment of patients in the emergency department. This summary was produced by Emergency Care BC (formerly the BC Emergency Medicine Network) and uses the best available knowledge at the time of publication. However, healthcare professionals should continue to use their own judgment and take into consideration context, resources and other relevant factors. Emergency Care BC is not liable for any damages, claims, liabilities, costs or obligations arising from the use of this document including loss or damages arising from any claims made by a third party. Emergency Care BC also assumes no responsibility or liability for changes made to this document without its consent.
Last Updated May 01, 2024
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