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.