Practice guidelines for evaluating new fever in critically ill adult patients

Naomi P. O'Grady, Philip S. Barie, John G. Bartlett, Thomas Bleck, Glenda Garvey, Judith Jacobi, Peter Linden, Dennis G. Maki, Myung Nam, William Pasculle, Michael D. Pasquale, Debra L. Tribett, Henry Masur

Research output: Contribution to journalReview articlepeer-review

98 Scopus citations


Objective: The development of practice guidelines for evaluating adult patients who develop new fever in the intensive care unit (ICU) for the purpose of guiding clinical practice. Participants: A task force of 13 experts in disciplines related to critical care medicine, infectious diseases, and surgery was convened from the membership of the Society of Critical Care Medicine and the Infectious Disease Society of America. Evidence: The task force members provided personal experience and determined the published literature (articles retrieved with use of MEDLINE or textbooks) from which consensus would be sought. The published literature was reviewed and classified into one of four categories, according to study design and scientific value. Consensus process: The task force met several times in person and twice monthly by teleconference over a 1-year period to identify the pertinent literature and arrive at consensus recommendations. Consideration was given to the relationship between the weight of scientific evidence and the experts' opinions. Draft documents were composed and debated by the task force until consensus was reached by nominal group process. Conclusions: The panel concluded that because fever can have many infectious and noninfectious etiologies, a new fever in an adult patient in the ICU should trigger a careful clinical assessment rather than automatic orders for laboratory and radiological tests. A cost-conscious approach to obtaining diagnostic studies should be undertaken if they are indicated after a clinical evaluation. The goal of such an approach is to determine, in a directed manner, whether infection is present so that additional testing can be avoided and therapeutic options can be identified.

Original languageEnglish (US)
Pages (from-to)1042-1059
Number of pages18
JournalClinical Infectious Diseases
Issue number5
StatePublished - 1998
Externally publishedYes

ASJC Scopus subject areas

  • Microbiology (medical)
  • Infectious Diseases


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