Observational studyJournal of general internal medicine2025
Added Value of Shaking Chills for Predicting Bacteremia in Patients with Suspected Infection.
Observational study in Journal of general internal medicine, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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10 authors.
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Abstract
backgroundDetailed grading of chills is more useful for diagnosing bacteremia than simply classifying the presence or absence of chills. However, its value added to other clinical information has not been evaluated.
objectiveTo evaluate the value of adding chills grading to other clinical information compared to simply noting the presence or absence of chills for predicting bacteremia in patients with suspected infection.
designProspective observational study.
participantsAdult patients admitted to two acute-care hospitals with suspected infection from April 2018 to March 2019. MAIN MEASURES: Two types of categorization for chills were applied: "presence" or "absence" (dichotomized chills); and "no chills", "mild/moderate chills", and "shaking chills" (trichotomized chills). Three multivariable logistic regression models incorporating each of dichotomized chills, trichotomized chills, and C-reactive protein (CRP) with other clinical information were developed and compared. To assess the potential consequences of using each model to identify patients with high risk of bacteremia (i.e., requiring prompt intervention), we applied a cut-off point of an estimated probability of 60%. The number of patients with bacteremia correctly identified by each model was compared. KEY
resultsAmong the 2,013 patients, 327 (16.2%) were diagnosed with bacteremia. The three models showed comparable discrimination and calibration performance. At the 60% cut-off, the dichotomized chills model correctly identified 11 patients (3.4% [95% confidence interval (CI) 1.9-3.4] of patients with bacteremia). The trichotomized chills model and CRP model correctly identified an additional 15 patients (4.6% [95% CI 2.8-7.4]) and 2 patients (0.6% [95% CI 0.1-2.3]) with bacteremia, respectively.
conclusionsDifferentiating shaking chills in comparison with dichotomized chills for predicting bacteremia allowed the correct identification of an additional 4.6% of patients with bacteremia. Detailed grading of chills can be assessed without additional time, cost, or burden on patients and can be recommended in the routine history taking.
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