Hyperpyrexia in children: clinical implications.

A prospective study was done to determine the incidence of serious illness in children under two years of age with hyperpyrexia (temperature of 41.1 degrees C [106 degrees F] or greater). Nineteen children were seen and followed in the emergency department of Oklahoma Children's Memorial Hospital over a one-year period. The final clinical diagnoses included acute otitis media, pneumonia, acute gastroenteritis, roseola, and cellulitis of the leg. In the entire group there was no meningitis or subsequent death. One child was hospitalized. The statistical analysis (binomial test at the 0.05 level) confirms that the incidence of serious illness manifested only by high fever is no higher than 0.15. The mere presence of very high fever does not necessarily indicate a serious illness. Laboratory and other diagnostic work-up and hospitalization should be based on clinical evaluations, rather than done routinely.