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

Ned Tijdschr Geneeskd. 2002 Jan 19;146(3):116-20.
[Article in Dutch]


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 degrees C rectal) presenting to the Casualty Department of the Leiden University Hospital and the Bronovo Hospital, in the period 1 February 1994-31 July 1995 respectively 1 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 11 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.

Publication types

  • English Abstract

MeSH terms

  • Aged
  • Bacteremia / diagnosis*
  • Bacteremia / epidemiology
  • Bacteremia / microbiology*
  • Chills / epidemiology
  • Chills / microbiology*
  • Diagnosis, Differential
  • Emergency Service, Hospital
  • Escherichia coli / isolation & purification
  • Female
  • Fever / microbiology
  • Humans
  • Male
  • Middle Aged
  • Netherlands / epidemiology
  • Predictive Value of Tests
  • Prognosis
  • Prospective Studies
  • Respiratory Tract Infections / diagnosis
  • Respiratory Tract Infections / microbiology
  • Streptococcus pneumoniae / isolation & purification
  • Urinary Tract Infections / diagnosis
  • Urinary Tract Infections / microbiology