Fever Without Focus (FWF) in Children: A Cross-sectional Study

Abstract

Background: Fever without focus (FWF) is a frequent diagnostic challenge in pediatric practice, occurring when febrile children present without any identifiable localizing signs. Objectives: Understanding its etiologies, clinical evolution, and optimal management is essential to avoid unnecessary testing and antibiotic use. Methods: This study included consecutive children aged 0 - 15 years presenting with fever ≤ 10 days and no focal findings on examination, with normal urinalysis and negative urine culture, at a tertiary pediatric outpatient clinic from 2015 to 2023. Demographic, clinical, laboratory, seasonal, and follow-up outcome data were collected. All children underwent structured follow-up at 24 - 72 hours and again at 7 days. Descriptive statistics were applied. Results: Of 16,325 children presenting with illness, 6,245 were febrile and 384 met criteria for FWF. Half were under 2 years old and 85% were younger than 5 years. Most cases occurred during warm seasons (63%). Final diagnoses were predominantly viral: Self-limited febrile illness (70%), roseola (9.3%), pharyngitis (4.1%), upper respiratory infections (4.1%), and viral gastroenteritis (4.1%). Urinary tract infection occurred in 2% and COVID-19 in 1.5% of cases. Approximately 75% of children became afebrile within 72 hours. Conclusions: Most FWF cases are viral and self-limiting. A structured follow-up strategy and age-based risk assessment enable safe management while minimizing unnecessary antibiotic use. Findings apply to similar outpatient pediatric settings with comparable epidemiological patterns.