Prevalence and Prognosis of Fever Symptoms, Hypo-, and Hyperthermia in Unselected Emergency Patients

Alexandra Malinovska,Christian H Nickel,Roland Bingisser,Liliana Malinovska

doi:10.3390/jcm11010024

Alexandra Malinovska, Christian H Nickel + Show 2 more

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https://doi.org/10.3390/jcm11010024

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Abstract

Assessments of history and body temperature are cornerstones of the diagnostic workup in all patients presenting to emergency departments (ED). Yet, the objective measurement of temperature and the subjective perception of fever can differ. This is a secondary exploratory analysis of a consecutive all-comer study, performed at an adult ED in Switzerland. Trained medical students interviewed all patients if fever was present. Altered temperature (>38.0 °C/<36.0 °C) measured at triage using an ear thermometer was used as the reference standard for diagnostic performance. In case of a disagreement between fever symptoms and altered temperature, discordance was noted. Outcome measures for case severity (acute morbidity, hospitalization, intensive care, and in-hospital mortality) were extracted from the electronic health records. Odds ratios (OR) for discordance between signs and symptoms and outcomes were calculated. Among 2183 patients, 325 patients reported fever symptoms. The sensitivity of fever symptoms as a test for altered temperature was 36.3%. Specificity was 91.5%. The negative predictive value was 84.1%, positive likelihood ratio was 4.2 and negative likelihood ratio was 0.7. The adjusted OR for discordance between fever symptoms and altered temperature was 1.71 (95% CI: 1.2–2.44) for acute morbidity, 1.56 (95% CI: 1.13–2.15) for hospitalization, and 1.12 (95% CI: 0.64–1.59) for intensive care. Unadjusted OR for mortality was 1.5 (95% CI: 0.69–3.25). Fever symptoms and altered temperature broadly overlap, but presentations can be stratified according to concordance between signs and symptoms. In case of discordance, the odds for acute morbidity and hospitalization are increased. Discordance may therefore be further investigated as a red flag for a serious outcome.

Highlights

Introduction iationsBody temperature is routinely assessed, e.g., at presentation to emergency departments (ED)
The study was performed at the emergency department (ED) of a 700-bed tertiary care hospital, where over 50,000 patients are seen per year
5634 presentations were recorded during the study periods, 4608 presentations were formally screened, and 2183 presentations were included (Figure 1)

Summary

Introduction

Body temperature is routinely assessed, e.g., at presentation to emergency departments (ED). The early recognition of hyper- and hypothermia is crucial for public health reasons, risk stratification, and protocol-based care. Body temperature can be taken as a sign only, or as a starting point for a work-up. Symptoms are starting points for clinical evaluation. There can be an obvious difference between the sign (objective measurement of temperature) and the symptom (subjective perception of fever). Some patients might perceive fever (“feel feverish”), but their body temperature is within normal ranges. Patients not feeling feverish may have a body temperature out of range

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