• Masataka Kudo, Toshihiko Takada, Kotaro Fujii, Sho Sasaki, Yu Yagi, Tetsuhiro Yano, Yasuhiro Tsuchido, Hideyuki Ito, Ken-Ei Sada, and Shunichi Fukuhara.
• Department of General Internal Medicine, Iizuka Hospital, Fukuoka, Japan.
• J Gen Intern Med. 2024 Dec 20.

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 MeasuresTwo 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.© 2024. The Author(s), under exclusive licence to Society of General Internal Medicine.

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