Background: Febrile shivering in the pediatric population is assumed to be related to a Severe Bacterial Infection (SBI). Research supporting this assumption is scant.
Objective: To describe the frequency of febrile shivering in the pediatric population arriving at the emergency department (ED) and to define its role in predicting a SBI.
Methods: A prospective study of children 3 months to 18 years was conducted in a pediatric ED. In patients with febrile shivering a sepsis workup was conducted including blood samples for inflammatory markers, blood culture, urinalysis and urine culture (when appropriate) . Other systems (CSF sampling, joint fluid aspiration, stool culture, chest x ray) were examined according to an appropriate history and clinical suspicion. The same work up was performed in patients presenting with fever without shivering. Primary outcome measure: Proportion of febrile children who experienced shivering and proportion of patients with severe bacterial infection
Results: Of 648 children with fever shivering was reported in 186 (28.7%). Sepsis workup was conducted in 86 children with shivering and 86 children without shivering, matched by age group, maximal fever and duration of fever. Mean WBC and CRP in children with and without shivering were 13.17 + 6.65 k/µL and 13.31 + 5.72 k/µL and 45.78 + 55.07 mg/l and 44.36 + 46.8 mg/l respectively. 18 (20.9%) children with shivering and 15 (17.4%) children without shivering suffered from SBI (P = 0.699). There were no children with bacteremia or meningitis.
Conclusions: Shivering is common in febrile children presenting to the ED and it is not associated with an increased risk for SBI.
