Clinical research studyThe degree of chills for risk of bacteremia in acute febrile illness
Section snippets
Patient assembly and data collection
In our prospective observational study, we enrolled consecutive patients (aged 15 years and older) who presented with acute febrile illness and were admitted to the emergency department of Okinawa Chubu Hospital, Japan. The hospital is a major community hospital and provides primary and specialty care to a population of approximately 400 000. Patient enrollment was from 2 periods (May to July and January to March) to include both summer and winter seasons.
The patient inclusion criteria were all
Statistical analysis
We used risk ratios as the primary measure of association for bacteremia of patients with different degrees of chills in reference to patients with no chills. We estimated risk ratios by multivariable Poisson regression rather than by using logistic regression in which odds ratio may overestimate true relative risk when analyzing common outcome.25 Risk ratio is also easier to understand for a nonepidemiologist than odds ratio.26 Additionally, we determined statistical characteristics such as
Results
We enrolled and analyzed a total of 526 consecutive febrile emergency department patients. Mean age was 57 years (range 15-106) and 248 (47%) were men. Table 1 shows the clinical characteristics for each degree of chills and total patients. Of 526 patients, 256 patients had no chills (48.7%; 95% confidence interval [CI] 44.3-53.0%); 105 patients had mild chills (20.0%; 95% CI 16.6-23.6%); 100 patients had moderate chills (19.0%; 95% CI 15.8-22.6%); and 65 patients had shaking chills (12.4%; 95%
Discussion
Our study showed that the increased degrees of chills indicated a higher risk of bacteremia in patients with acute febrile illness. Particularly, patients with shaking chills had the greatest risk of bacteremia. Our data highlight the prudent use of qualitative chill degrees when interviewing patients with acute febrile illness. We may need to elicit a more precise focus on this useful component of clinical history. Moreover, the diligent observant medical interview has minimal cost while it
Acknowledgment
We thank Mrs. Tomoko Yonaha for her excellent secretarial support.
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2019, American Journal of MedicineHigh positivity of blood cultures obtained within two hours after shaking chills
2018, International Journal of Infectious DiseasesCitation Excerpt :This was because it was believed that there was a time lag of around an hour between the abrupt influx of bacteria and the onset of chills (Bennett and Beeson, 1954). The most severe degree of chills, namely shaking chills or shivering, has been considered a strong predictor of bacteremia (Bates et al., 1990; Tokuda et al., 2005). Shaking chills have been a useful indicator of bacteremia even in elderly patients with dementia, because they are easily recognized (Taniguchi et al., 2013).
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2017, Journal of Microbiology, Immunology and InfectionDevelopment and validation of a parsimonious and pragmatic CHARM score to predict mortality in patients with suspected sepsis
2017, American Journal of Emergency MedicineCitation Excerpt :In contrast to our results, the presence of chills has often been deemed a sign of active infection, or a ‘toxic’ sign. Chills has also been associated with higher circulating tumor necrosis factor-α and interleukin-10 levels [19,20] and the presence of bacteremia [21-23]. One explanation is that ED patients often remained in an early stage of sepsis, at which point not many patients developed chills as a presenting symptom.
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2016, Journal of Emergency MedicineRisk of bacteremia in patients presenting with shaking chills and vomiting - A prospective cohort study
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