Prospective Studies Comparing Structured vs Nonstructured Diagnostic Protocol Evaluations Among Patients With Fever of Unknown Origin

Wright, William F.; Betz, Joshua; Auwaerter, Paul G.

doi:10.1001/jamanetworkopen.2022.15000

Cited by 9 publications

(10 citation statements)

References 30 publications

(188 reference statements)

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“…Outcome measures have been the preferred approach for developing quality infectious disease indicators because process measures are not always a perfectly mapped surrogate for the desired result, particularly among conditions with significant heterogeneity such as FUO and IUO [ 2 , 12 ]. For example, educating clinicians on utilizing protocolized (algorithmic) FUO or IUO diagnostic evaluations does not necessarily result in the reduction of patients remaining undiagnosed, nor is physician education the only way to improve achieving a diagnosis [ 13 ]. Outcome measures can also be supplemented with statistical methods, such as stratification or risk adjustment, that control for factors that influence the relationship between a predictor and outcome that is often out of the clinician's control [ 14 , 15 ].…”

Section: Discussionmentioning

confidence: 99%

“…FUO and IUO are conditions without defined optimal evaluation and management strategies [ 5 , 13 ]. To date, no high-quality randomized controlled trials have been performed [ 5 ].…”

Section: Discussionmentioning

confidence: 99%

“…However, the Delphi method is a well-acknowledged strategy to approach a situation inherent in this study, where there is insufficient evidence to make recommendations [ 10 , 11 ]. Finally, the results that we present are subject to variations within geographic locations and societies regarding the use of health care resources [ 13 ].…”

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Development of a Consensus-Based List of Potential Quality Indicators for Fever and Inflammation of Unknown Origin

Wright,

Betrains,

Stelmash

et al. 2024

Open Forum Infectious Diseases

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Section: Discussionmentioning

confidence: 99%

“…FUO and IUO are conditions without defined optimal evaluation and management strategies [ 5 , 13 ]. To date, no high-quality randomized controlled trials have been performed [ 5 ].…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Development of a Consensus-Based List of Potential Quality Indicators for Fever and Inflammation of Unknown Origin

Wright,

Betrains,

Stelmash

et al. 2024

Open Forum Infectious Diseases

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show abstract

“…Despite diagnostic advances, it has been reported that in high-income countries half of the cases of FUO and IUO remain undiagnosed [ 96 , 105 ]. According to a recent study, diagnostic evaluation of FUO and IUO should be based on local disease prevalence, and individual presentations [ 106 ].…”

Section: Fever Of Unknown Origin (Fuo) and Inflammation Of Unknown Or...mentioning

confidence: 99%

Microbial and Host Metabolites at the Backstage of Fever: Current Knowledge about the Co-Ordinate Action of Receptors and Molecules Underlying Pathophysiology and Clinical Implications

et al. 2023

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Fever represents an elevation of body temperature, that exerts a protective effect against pathogens. Innate immune cells and neurons are implicated in the regulation of body temperature. Pathogen-associated molecular patterns, i.e., lipopolysaccharides from Gram-negative bacteria and peptidoglycan and lipoteichoic acid from Gram-positive bacteria are exogenous pyrogens, that bind to Toll-like receptors on immune and non-immune cells. The subsequent release of pro-inflammatory cytokines [interleukin-1 (IL-1), IL-6 and Tumor necrosis factor-alpha] and their passage through the brain trigger the febrile response. In fact, neurons of the pre-optic area produce prostaglandin E2 (PGE2), that, in turn, bind to the PGE2 receptors; thus, generating fever. Apart from classical non-steroidal anti-inflammatory drugs, i.e., aspirin and acetaminophen, various botanicals are currently used as antipyretic agents and, therefore, their mechanisms of action will be elucidated.

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“…Advances in clinical research and diagnostic testing methods over the last 3 decades suggest that an update for existing definitions and approaches for fever and inflammation of unknown origin is needed [ 1–4 ]. Classic fever of unknown origin (FUO) was first robustly studied in 1961, with subsequent modifications in definitions ( Table 1 ) [ 1 , 2 ]. These FUO definitions require an illness of ≥3 weeks duration and temperatures of ≥38.3°C (≥100.9°F) on several occasions [ 1 , 2 ].…”

mentioning

confidence: 99%

Recommendations for Updating Fever and Inflammation of Unknown Origin From a Modified Delphi Consensus Panel

Wright,

Stelmash,

Betrains

et al. 2024

Open Forum Infectious Diseases

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Background Fever of unknown origin (FUO) and inflammation of unknown origin (IUO) are syndromes commonly used as medical diagnoses. Since the existing literature has a mixture of diagnostic approaches, developing consensus-based recommendations would be helpful for clinicians, researchers, and patients. Methods A modified Delphi process was performed from October 2022 to July 2023, involving 4 rounds of online surveys and 2 live video conferences. The panel comprised international experts recruited based on peer-reviewed published publications and studies. Results Among 50 invited experts, 26 (52.0%) agreed to participate. Twenty-three panelists completed round 1 of the survey, 21 completed rounds 2 and 3, 20 completed round 4, and 7 participated in round 5 live video discussions. Of the participants, 18 (78.3%) were academic-based clinicians and researchers, 5 (21.7%) practiced in a community-based hospital, and 6 (26.1%) were female. Consensus was reached on 5 themes: (1) incorporating epidemiologic factors, such as geographic location and travel history; (2) updated criteria for classifying FUO or IUO; (3) initial evaluation approaches; (4) a classification system for diagnoses; and (5) recommendations for judicious limitation of empiric therapies. Experts strongly disagreed with using 2-deoxy-2-[18F] fluoro-D-glucose positron emission tomography/computed tomography as part of the diagnostic criteria for FUO. There were mixed opinions about the importance of the temperature measurement site, the 3-week minimum illness criterion, the need for a standard definition of relapsing fevers, and the use of similar evaluation strategies for FUO and IUO. Conclusions These Delphi-generated consensus-based recommendations offer potential improvements compared with earlier definitions and a guide for clinical practice and future research.

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Prospective Studies Comparing Structured vs Nonstructured Diagnostic Protocol Evaluations Among Patients With Fever of Unknown Origin

Abstract: This systematic review and meta-analysis compares diagnostic yield studies using a structured or a nonstructured diagnostic approach to treating patients with fever of unknown origin syndrome.

Cited by 9 publications

References 30 publications

Development of a Consensus-Based List of Potential Quality Indicators for Fever and Inflammation of Unknown Origin

Development of a Consensus-Based List of Potential Quality Indicators for Fever and Inflammation of Unknown Origin

Microbial and Host Metabolites at the Backstage of Fever: Current Knowledge about the Co-Ordinate Action of Receptors and Molecules Underlying Pathophysiology and Clinical Implications

Recommendations for Updating Fever and Inflammation of Unknown Origin From a Modified Delphi Consensus Panel

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