Evaluation of children with fever greater than or equal to 104 degrees F in an emergency department.

Two hundred five children with a temperature greater than or equal to 104 degrees F seen in a pediatric emergency department were studied over a six-month fall-winter period to determine the patterns of illness and hospitalization. Children over five years composed a large group (38%) of patients admitted. The proportions of patients with viral and bacterial illnesses (40 and 45%) were similar, as were hospitalization rates for the two types of illnesses (11 and 14%). The hospitalization rates did not change if pneumonias were considered all bacterial or all viral. Chest x-rays were done in 103 patients, and pneumonia was diagnosed in 26 with 18 (69%) occurring in children older than 24 months. There were 10 adolescents greater than or equal to 12 years, five of whom had Group A streptococcal pharyngitis. Blood cultures were drawn in 85 patients, and bacteremia occurred in 12 patients, all younger than 24 months. This study shows that significant illnesses and a high proportion of hospitalizations occurred in children of all ages, particularly in children older than five years.