This version was machine-translated from German and has not been medically reviewed. The authoritative version is the German version.

Feverkidstool / Risk of pneumonia and other serious bacterial infections in fever (Nijman 2013)

Polytomous model of age, sex, temperature, fever duration, vital signs, overall impression and CRP: Risk of pneumonia und einer anderen schweren bakteriellen Infektion bei Kindern von 1 Monat bis 15 Jahren mit Fieber

Child

Age

Sex

male female

Fever

Temperature in the emergency department (°C)

Fever duration (days)

More than 6 days count as 6 days.

Findings

Respiratory rate (/min)

Tachypnoea by APLS: under 1 year above 40, 1 to under 2 years above 35, 2 to under 5 years above 30, from 5 years über 25 pro Minute.

Heart rate über der APLS-Grenze für das Alter (Tachycardia)

Oxygen saturation (SpO₂) below 94 %

Capillary refill time over 3 seconds

2 to 4 seconds did not count as over 3 seconds in the authors' calculator.

Chest wall retractions

Ill appearance (overall impression)

Laboratory

CRP

Note the unit: 1 mg/dl = 10 mg/l. Over 225 mg/l counts as 225 mg/l.

Calculation aid for healthcare professionals: the calculator reproduces what the sources cited assign to the inputs. Clinical assessment and every treatment decision remain with the treating physician. Inputs and results are not stored.

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Sources

Clinical prediction model to aid emergency doctors managing febrile children at risk of serious bacterial infections: diagnostic study (BMJ 346:f1706) Nijman RG, Vergouwe Y, Thompson M, van Veen M, van Meurs AHJ, van der Lei J, Steyerberg EW, Moll HA, Oostenbrink R, 2013. Derivation and external validation (PMID 23550046, PMC3614186), 2717 children from Rotterdam and The Hague, validation in 487 children in Coventry; Full text, table 3 and appendices A–E, “Digital calculator” and “Legend for digital calculator” read; License CC BY-NC 3.0
Evaluation of a clinical decision rule to guide antibiotic prescription in children with suspected lower respiratory tract infection in the Netherlands: a stepped-wedge cluster randomised trial (PLoS Med 17:e1003034), S1 Text: study protocol version 7 van de Maat JS, Peeters D, Nieboer D, et al., Oostenbrink R, 2020. Study protocol with the formula for pneumonia (three decimal places, figure 3); License CC BY
Derivation and validation of age and temperature specific reference values and centile charts to predict lower respiratory tract infection in children with fever (BMJ 345:e4224) Nijman RG, Thompson M, van Veen M, Perera R, Moll HA, Oostenbrink R, 2012. Footnote to table 4: APLS limits for respiratory rate by age (same APLS source as in the Feverkidstool: Turner NM, APLS, 2nd ed. 2006)

Related calculators

Note

Calculation aid for healthcare professionals. Clinical assessment remains with the treating physician.

Review date of the German original: 2026-11-09 · Methodology

For parents (in German): Fever in children (kinderarzt.net)

Frequently asked questions

Feverkidstool / Risk of pneumonia and other serious bacterial infections in fever (Nijman 2013): What does this calculator compute?

The Feverkidstool (Nijman 2013, BMJ) estimates two risks in children aged 1 month to under 16 years with fever in the emergency department: a pneumonia and another serious bacterial infection (for example urinary tract infection, sepsis or meningitis). It uses age, sex, temperature, fever duration, tachypnoea, tachycardia, oxygen saturation below 94 %, capillary refill time over 3 seconds, chest wall retractions, ill appearance and CRP. Below 2.5 % an infection was unlikely in the derivation, from 10 % clearly more likely. The authors' worked example (10.9 % and 4.3 %) gives 10.8 % and 5.1 % here; the difference is due to rounded coefficients.

Feverkidstool / Risk of pneumonia and other serious bacterial infections in fever (Nijman 2013): Which sources is this calculator based on?

Nijman RG, Vergouwe Y, Thompson M, van Veen M, van Meurs AHJ, van der Lei J, Steyerberg EW, Moll HA, Oostenbrink R: Clinical prediction model to aid emergency doctors managing febrile children at risk of serious bacterial infections: diagnostic study (BMJ 346:f1706) (2013); van de Maat JS, Peeters D, Nieboer D, et al., Oostenbrink R: Evaluation of a clinical decision rule to guide antibiotic prescription in children with suspected lower respiratory tract infection in the Netherlands: a stepped-wedge cluster randomised trial (PLoS Med 17:e1003034), S1 Text: study protocol version 7 (2020); Nijman RG, Thompson M, van Veen M, Perera R, Moll HA, Oostenbrink R: Derivation and validation of age and temperature specific reference values and centile charts to predict lower respiratory tract infection in children with fever (BMJ 345:e4224) (2012)