A Prospective Multicenter Study on Fever of Unknown Origin: The Yield of a Structured Diagnostic Protocol

• Published in: Medicine (Baltimore) 2007-01, Vol.86 (1), p.26-38
• Main Authors: Bleeker-Rovers, Chantal P., Vos, Fidel J., de Kleijn, Elisabeth M. H. A., Mudde, Aart H., Dofferhoff, Ton S. M., Richter, Clemens, Smilde, Tineke J., Krabbe, Paul F. M., Oyen, Wim J. G., van der Meer, Jos W. M.
• Format: Article
• Language: English
• Subjects: Adult; Aged; Clinical Laboratory Techniques; Clinical Protocols; Diagnostic Imaging; Diagnostic Techniques, Surgical; Diagnostic Tests, Routine; Female; Fever of Unknown Origin - etiology; Histological Techniques; Humans; Male; Middle Aged; Prospective Studies
• ISSN: 0025-7974
• DOI: 10.1097/MD.0b013e31802fe858

We conducted a prospective study to update our knowledge of fever of unknown origin (FUO) and to explore the utility of a structured diagnostic protocol. From December 2003 to July 2005, 73 patients with FUO were recruited from 1 university hospital (n = 40) and 5 community hospitals (n = 33) in the same region in The Netherlands. FUO was defined as a febrile illness of >3 weeks' duration, a temperature of >38.3 degrees C on several occasions, without a diagnosis after standardized history-taking, physical examination, and certain obligatory investigations. Immunocompromised patients were excluded. A structured diagnostic protocol was used. Patients from the university hospital were characterized by more secondary referrals and a higher percentage of periodic fever than those referred to community hospitals. Infection was the cause in 16%, a neoplasm in 7%, noninfectious inflammatory diseases in 22%, miscellaneous causes in 4%, and in 51%, the cause of fever was not found (no differences between university and community hospitals). There were no differences regarding the number and type of investigations between university and community hospitals. Significant predictors for reaching a diagnosis included continuous fever; fever present for