CLINICAL STUDIES Fever in Hospitalized Patients With Special Reference to the Medical Service JOHN E. MCGOWAN, Jr., M.D. RICHARD C. ROSE, M.D.* NORMAN F. JACOBS, M.D.+ DENNIS R. SCHABERG, M.D.t ROBERT W. HALEY, M.D.5 A tianta, Georgia From the Departments of Pathology and Labora- tory Medicine, and the Department of Medicine (Infectious Diseases), Emory University School of Medicine (Drs. McGowan, Rose, and Jacobs), and the Hospital Infections Branch, Center for Infectious Diseases, Centers for Disease Control (Drs Schaberg and Haley), Atlanta, Georgia. Re- quests for reprints should be addressed to Dr. John E. McGowan, Jr., Clinical Microbiology (Box 248), Grady Memorial Hospital, 80 Butler Street, Atlanta, Georgia 30335. Manuscript submitted July 16, 1986, and accepted September 29, 1986. *Current address: Suite 204, 2001 Laurel Ave- nue, Knoxville, Tennessee 37916. %urrent address: Department of Medicine, De- kaib General Hospital, Decatur, Georgia 30033. :Current address: Division of Infectious Dis- eases, University of Michigan School of Medi- cine, Ann Arbor, Michigan 48109. ‘%urrent address: Department of Medicine, Southwestern Medical School, University of Tex- as Health Science Center, Dallas, Texas 75235. Fever (oral temperature of 38% or more on two or more consecutive days) during the hospital stay of 4,065 patients admitted to Grady Memorial Hospital during an 11 -week period was studied. At least one episode of fever occurred in 1,194 patients (29 percent). Rates of fever were highest on medical and surgical services. Review of 341 episodes of fever in 302 patients on the medical service identified a single potential cause in 56 percent. Multiple factors were present in 26 percent, and no potential causes were found in 18 percent. of 390 factors identified, 44 percent were community-acquired infections, 9 percent were nosocomial infections, 20 percent possibly involved infection, and 26 percent were noninfectious processes. Fever is a frequent finding in hospitalized patients. Both infectious and noninfec- tious processes play important roles. Determining the cause of fever is complicated by the multiplicity of possible causes. Most published studies on the etiologic and epidemiologic characteristics of fever are concerned with the specific problem of fever of unknown origin (fever of at least three weeks’ duration in which the source of fever is unclear after a week of hospital investigation) [ 11. However, patients in this group represent only a small fraction of hospitalized patients with fever. Although patients on obstetric-gynecology services have been examined for the occurrence and causes of fever [2], the overall impact of fever in a general hospital population has been examined Only infre- quently [3-51, and incidence rates for medical service patients have been published only in abstract form [6] or for countries other than the United States [7,8]. To add to the information available on this important clinical problem, we returned to a data base collected prospectively for an earlier study [9, lo], and reviewed information collected but not analyzed at that time concerning the occurrence and cause of febrile episodes in patients admitted during an 1 l-week period to Grady Memorial Hospital, a munici- pal hospital predominantly serving indigent patients in Atlanta, Georgia. We have now supplemented those data by reviewing the clinical records for febrile patients on the medical service to provide more detail on possible causes of infection. PATIENTS AND METHODS As part of a prospective study of diagnosis [9] and cost [IO,1 l] of nosocomial infections, seven specially trained registered nurses had identi- fied all patients admitted to the medical, surgical, obstetrics-gynecology, pediatric, and newborn intensive care services at Grady Memorial Hospital during an Ii-week period (June 16 to August 31, 1975). The nurses 589 March 23, 1987 The American Journal of Medicine Volume 82