The impact of global budgeting in Taiwan on inpatients with unexplained fever

Liu, Keh-Sen; Yu, Tsung-Fu; Wu, Hsing-Ju; Lin, Chun-Yi

Infections are the main causes of FUO in children, [8, 25, 26, 40] including the children in Taiwan. [41, 42] Notably, a significant proportion of pediatric patients, accounting approximately 25%-30%, remain undiagnosed. [8, 25, 26, 40] However, in adults, the number of undiagnosed cases has been demonstrated to be more common than that of the infectious etiology cases. [15, 43] As fluorodeoxyglucose positron emission tomography (FDG-PET)/CT emerged in the end of 20th century, [44] it was applied for the diagnosis of FUO. Compared to conventional scintigraphic techniques, FDG-PET/CT has following advantages: higher resolution and higher sensitivity for anatomic localization of infectious, inflammatory, or neoplastic processes. [45] The workup of patients with FUO demonstrated that the diagnostic performance of 18 F-FDG-PET/CT is superior to 67 Ga singlephoton emission computed tomography (SPECT)/CT. [46] Furthermore, previous studies have suggested that using FDG-PET/ CT shortened the diagnostic work-up for FUO. [15, 47] A metaanalysis reported that PET and PET/CT had successfully localized the source of fever in 44% and 58% of the patients with classic FUO, respectively, after a series of unsuccessful investigations. [48] The major drawbacks are cost and accessibility; FDG-PET/CT costed £800, compared with £250 for a chest-abdomen-pelvis Table 6 The impact of several independent variables on the risk of revisiting ED within 3 days and the risk of re-admission within 14 days among the patients with unexplained fever (Generalized binary linear model).