Emergency department management of pediatric patients with cyanotic heart disease and fever

Background: Children with cyanotic congenital heart disease (CCHD) are living longer and presenting to the Emergency Department (ED) in larger numbers. A greater understanding of their diagnoses and appropriate management strategies can improve outcomes.

Objective: Our objective was to describe the ED diagnoses, management, and dispositions of pediatric CCHD patients who present with fever.

Methods: We retrospectively analyzed pediatric ED patients age 18 years or younger with a previous diagnosis of CCHD who presented with a fever from January 2000 to December 2005.

Results: Of 809 total ED encounters, 248 (30.6%) were eligible for inclusion. Of those meeting inclusion criteria, 59 (23.8%) required supplemental oxygen and 67 (27%) received intravenous fluid. ED diagnoses were febrile illness in 120 (48.4%), pneumonia in 35 (14.1%), upper respiratory infection in 19 (7.7%), viral syndrome in 17 (6.9%), gastroenteritis in 17 (6.9%), otitis media in 10 (4.0%), bronchiolitis in 5 (2.0%), pharyngitis in 3 (1.2%), croup in 3 (1.2%), bronchitis in 3 (1.2%), urinary tract infection in 3 (1.2%), mononucleosis in 2 (0.8%), pericarditis in 2 (0.8%), influenza in 1 (0.4%), cellulitis in 1 (0.4%), bacteremia in 1 (0.4%), and potential endocarditis in 1 (0.4%). In terms of patient disposition, 53.2% were discharged, 44.4% were floor admissions, and 2.4% were intensive care unit admissions.

Conclusions: A cardiac cause of fever in CCHD patients is rare. Because of limited cardiopulmonary reserve, they might require supplemental oxygen, intravenous fluids, and hospital admission.