Motivation: Clinical lore has it that pulmonary embolism (PE) causes low grade fevers and should not cause a fever as high as 103F. While deciding on the often pondered question of whether or not a person has PE, I have seen the degree of fever sway the decision one way or the other. But, is this true?
Paper: Stein, PD, Afzal, A, Henry, J, et. al. "Fever in Acute Pulmonary Embolism" Chest (2000); 117:39-42.
Methods: In the PIOPED (Prospective Investigation of Pulmonary Embolism Diagnosis) study, retrospective analysis was made of presence of fever in patients with angiographically proven pulmonary embolism (PE).
Results:
Cohort: There were 363 patients from PIOPED study analyzed for this study. Fever was present in 95 patients (26%; 95% CI: 22-31%). Of the 95 patients with fever, 43 (45.3%) did not have other causes of fever - solely attributed to PE. There were 46 (48.4%) patients who had an alternative possible etiology of fever - 15 with malignancy, 10 with infection, 6 with recent operation (top three causes). Six did not have further investigation (so indeterminate cause). Fever was not more frequent in patients with pulmonary hemorrhage or infarction than in those without.
Maximum Temperature: Of the 43 patients with available information on temperature, the maximum temperature was 100 to 100.9F in 24, 101 to 101.9F in 14, 102-102.9 in 3. One patient each had maximum temperature between 103-103.9 and greater than 104F.
Discussion: The clinical lore turns out to be mostly true - majority of patients with PE associated fever have maximum temperature less than 102F. What I thought was most cautionary, however, is that fever is an infrequent finding in PE (present in only about a fourth). Even among those with fever, they were just as likely to have an alternate explanation as pulmonary embolism. What I took away from this paper is that if patients with PE have fever, they still need a thoughtful workup.
Paper: Stein, PD, Afzal, A, Henry, J, et. al. "Fever in Acute Pulmonary Embolism" Chest (2000); 117:39-42.
Methods: In the PIOPED (Prospective Investigation of Pulmonary Embolism Diagnosis) study, retrospective analysis was made of presence of fever in patients with angiographically proven pulmonary embolism (PE).
Results:
Cohort: There were 363 patients from PIOPED study analyzed for this study. Fever was present in 95 patients (26%; 95% CI: 22-31%). Of the 95 patients with fever, 43 (45.3%) did not have other causes of fever - solely attributed to PE. There were 46 (48.4%) patients who had an alternative possible etiology of fever - 15 with malignancy, 10 with infection, 6 with recent operation (top three causes). Six did not have further investigation (so indeterminate cause). Fever was not more frequent in patients with pulmonary hemorrhage or infarction than in those without.
Maximum Temperature: Of the 43 patients with available information on temperature, the maximum temperature was 100 to 100.9F in 24, 101 to 101.9F in 14, 102-102.9 in 3. One patient each had maximum temperature between 103-103.9 and greater than 104F.
Discussion: The clinical lore turns out to be mostly true - majority of patients with PE associated fever have maximum temperature less than 102F. What I thought was most cautionary, however, is that fever is an infrequent finding in PE (present in only about a fourth). Even among those with fever, they were just as likely to have an alternate explanation as pulmonary embolism. What I took away from this paper is that if patients with PE have fever, they still need a thoughtful workup.
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