Shivering has little diagnostic value in diagnosing serious bacterial infection in children: a systematic review and meta-analysis

Vandenberk, Maud; Bondt, Kasper De; Nuyts, Emma; Toelen, Jaan; Verbakel, Jan Y

doi:10.1007/s00431-020-03870-7

Cited by 4 publications

(4 citation statements)

References 29 publications

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“…This is the first systematic review to have assessed the diagnostic accuracy of shaking chills in adult patients with suspected bacteremia, without consideration of underlying illnesses or the patient’s infective state. Although one systematic review focusing on shaking chills as an index test has been reported, this research focused on children and targeted not only bacteremia but also other serious bacterial infections, such as sepsis, meningitis, pneumonia, pyelonephritis, osteomyelitis, septic arthritis, or cellulitis [ 10 ]. Thus, while the diagnostic ability of shaking chills had been limited to diagnose these infections without malignancy, shaking chills was helpful in patients with malignancy due to a significantly positive likelihood ratio of 3.47 (95% CI, 2.58 to 4.36).…”

Section: Discussionmentioning

confidence: 99%

“…Thus, shaking chills possibly constitute a more reliable and recognizable sign in patients with suspected bacteremia, especially in cases where patients present with a difficulty in their verbal communication, such as in dementia [ 9 ]. Previous studies have shown the predictive value of shaking chills in diagnosing bacteremia [ 8 , 9 ]; however, a systematic review involving children has indicated conflicting results [ 10 ], and most of the original diagnostic studies had small sample sizes. Therefore, there is a need to synthesize these findings to better understand the clinical impact of shaking chills on the prediction of bacteremia in adults.…”

Section: Introductionmentioning

confidence: 99%

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Utility of shaking chills as a diagnostic sign for bacteremia in adults: a systematic review and meta-analysis

Aita,

Nakagawa,

Takahashi

et al. 2024

BMC Med

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Background Accurate prediction of bacteremia is essential for guiding blood culture collection and optimal antibiotic treatment. Shaking chills, defined as a subjective chill sensation with objective body shivering, have been suggested as a potential predictor of bacteremia; however, conflicting findings exist. To address the evidence gap, we conducted a systematic review and meta-analysis of studies to assess the diagnostic accuracy of shaking chills for predicting bacteremia among adult patients. Methods We included studies reporting the diagnostic accuracy of shaking chills or chills for bacteremia. Adult patients with suspected bacteremia who underwent at least one set of blood cultures were included. Our main analysis focused on studies that assessed shaking chills. We searched these studies through CENTRAL, MEDLINE, Embase, the World Health Organization ICTRP Search Portal, and ClinicalTrials.gov. Study selection, data extraction, evaluation for risk of bias, and applicability using the QUADAS-2 tool were conducted by two independent investigators. We estimated a summary receiver operating characteristic curve and a summary point of sensitivity and specificity of the index tests, using a hierarchical model and the bivariate model, respectively. Results We identified 19 studies with a total of 14,641 patients in which the accuracy of shaking chills was evaluated. The pooled sensitivity and specificity of shaking chills were 0.37 (95% confidence interval [CI], 0.29 to 0.45) and 0.87 (95% CI, 0.83 to 0.90), respectively. Most studies had a low risk of bias in the index test domain and a high risk of bias and a high applicability concern in the patient-selection domain. Conclusions Shaking chills are a highly specific but less sensitive predictor of bacteremia. Blood cultures and early initiation of antibiotics should be considered for patients with an episode of shaking chills; however, the absence of shaking chills must not lead to exclusion of bacteremia and early antibiotic treatment.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Utility of shaking chills as a diagnostic sign for bacteremia in adults: a systematic review and meta-analysis

Aita,

Nakagawa,

Takahashi

et al. 2024

BMC Med

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“…The dependent variable was SBI. According to the previously reported study [ 17 ], SBI was defined as suffering from one of the following diseases: pyelonephritis, bacteraemia, bacterial meningitis, sepsis, pneumonia, cellulitis, and osteomyelitis. These diseases were identified from the medical record.…”

Section: Methodsmentioning

confidence: 99%

A diagnostic model based on routine blood examination for serious bacterial infections in neonates–a cross-sectional study

Liang¹,

Chen²,

Shen³

et al. 2023

Epidemiol. Infect.

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Routine blood examination is an easy way to examine infectious diseases. This study is aimed to develop a model to diagnose serious bacterial infections (SBI) in ICU neonates based on routine blood parameters. This was a cross-sectional study, and data were extracted from the Medical Information Mart for Intensive Care III (MIMIC-III). SBI was defined as suffering from one of the following: pyelonephritis, bacteraemia, bacterial meningitis, sepsis, pneumonia, cellulitis, and osteomyelitis. Variables with statistical significance in the univariate logistic regression analysis and log systemic immune–inflammatory index (SII) were used to develop the model. The area under the curve (AUC) was calculated to assess the performance of the model. A total of 1,880 participants were finally included for analysis. Weight, haemoglobin, mean corpuscular volume, white blood cell, monocyte, premature delivery, and log SII were selected to develop the model. The developed model showed a good performance to diagnose SBI for ICU neonates, with an AUC of 0.812 (95% confidence interval (CI): 0.737–0.888). A nomogram was developed to make this model visualise. In conclusion, our model based on routine blood parameters performed well in the diagnosis of neonatal SBI, which may be helpful for clinicians to improve treatment recommendations.

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“…Shivering or rigors is an intermediate risk ("amber") sign in the NICE Traffic light system [2]. However, a recent systematic review on the diagnostic value of shivering [164] with regards to SBI has found that, while significantly associated with serious infection in children with known malignancies (LR (+) (95 % CI) = 3.47 (2.58-4.36), shivering has poor diagnostic value in children with no malignancies [165][166][167][168].…”

Section: Shiveringmentioning

confidence: 99%

Diagnostic Value of Clinical Presentation, Parental Concern, and Clinician’s Non-Analytical Reasoning in Identifying Serious Bacterial Infections in Febrile Children. Doctoral Thesis

Urbãne¹

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Fever is one of the main reasons for visits to paediatric emergency departments (ED). Although in most cases the underlying cause is self-limiting viral infections, 4 to 25 % of children visiting ED with fever develop serious bacterial infections (SBI), which are significant causes of childhood mortality, even in developed countries. Due to high number of patients visiting ED with febrile illness, rapid discrimination between children with and without possible SBI is challenging.This study aimed to improve early recognition of SBI in children who present to ED by assessing the diagnostic value of clinical signs at presentation, clinician’s non-analytical reasoning, defined as “gut feeling” of serious illness and “sense of reassurance”, and parental concern of different / more severe illness. Based on these variables, derivation and external validation of two clinical prediction models (CPMs) for SBI was performed, and the performance of a CPM based on clinical variables alone was compared to a model integrating clinical features together with variables of non-analytical reasoning. The models were derived from a dataset of 517 febrile patients presenting to the ED of Children’s Clinical University Hospital (CCUH) in Riga, and externally validated in a dataset of 188 patients prospectively enrolled in six regional hospitals in Latvia.While the prognostic value of clinician’s “gut feeling” as an independent variable for diagnosing SBI was limited, “sense of reassurance” was significantly predictive of absence of SBI, and the performance of the CPM 2 integrating the non-analytical variables with clinical features was superior in both derivation (Receiver Operating Characteristic curve (ROC) Area Under Curve (AUC) 0.783, 95 % confidence interval (CI) 0.727–0.839) and validation cohorts (ROC AUC 0.752, 95 % CI 0.674–0.830), when compared to the performance of the CPM 1, which was based solely on clinical variables (ROC AUC in derivation population 0.738, 95 % CI 0.688–0.788, in validation population 0.677, 95 % CI 0.586–0.767). Both CPMs had moderate ability to predict SBI in febrile children presenting to ED and acceptable performance in the validation cohort. A scoring system based on the superior prediction model was created to distinguish between patients with high or low risk of SBI, as well as to identify patients in diagnostic “grey area”, in which the severity of manifestations of SBI and mild infections overlapped. Contrary to studies in primary care performed in other European countries, parental concern was not significantly predictive of SBI. Elements of fever-related anxiety were identified as factors influencig the level of parental concern and urging parents to present to healthcare early. A qualitative interview study including 34 parents of patients enrolled in derivation cohort revealed existing misconceptions regarding the possible negative effects of fever, which often were a result of unfulfilled educational and emotional needs when caring for a febrile child. This study suggests that educational intervention is necessary to reduce “fever phobia” in parents and to improve the diagnostic reliability of parental concern.

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Shivering has little diagnostic value in diagnosing serious bacterial infection in children: a systematic review and meta-analysis

Cited by 4 publications

References 29 publications

Utility of shaking chills as a diagnostic sign for bacteremia in adults: a systematic review and meta-analysis

Utility of shaking chills as a diagnostic sign for bacteremia in adults: a systematic review and meta-analysis

A diagnostic model based on routine blood examination for serious bacterial infections in neonates–a cross-sectional study

Diagnostic Value of Clinical Presentation, Parental Concern, and Clinician’s Non-Analytical Reasoning in Identifying Serious Bacterial Infections in Febrile Children. Doctoral Thesis

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