Prevalence and Prognosis of Fever Symptoms, Hypo-, and Hyperthermia in Unselected Emergency Patients
Abstract
:1. Introduction
2. Materials and Methods
2.1. Study Design and Setting
2.2. Selection of Patients
2.3. Data Collection
2.4. Triage
2.5. Measurements and Outcomes
2.6. Stratifications
- 2(A) Presentations with concordance of perceived fever and measured temperature:
- ○
- A1: Fever symptoms perceived and temperature out of range;
- ○
- A2: No fever symptoms perceived and temperature in range.
- 2(B) Presentations with discordance of perceived fever and measured temperature:
- ○
- B1: Fever symptoms perceived, but temperature in range;
- ○
- B2: No fever symptoms perceived, but temperature out of range.
2.7. Statistical Analyses
3. Results
3.1. Characteristics of Study Subjects
3.1.1. Patient Strata According to Temperature
3.1.2. Patient Strata According to Symptoms
3.1.3. Patient Strata According to Concordance of Perceived and Measured Temperature
3.2. Diagnostic Test Performance
3.3. Association to Outcome Measures
4. Discussion
Limitation
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
- Al-Almaie, S.M. Ability of adult patients to predict absence or presence of Fever in an emergency department triage clinic. J. Fam. Community Med. 1999, 6, 29–34. [Google Scholar]
- Buckley, R.G.; Conine, M. Reliability of subjective fever in triage of adult patients. Ann. Emerg. Med. 1996, 27, 693–695. [Google Scholar] [CrossRef]
- Singh, M.; Pai, M.; Kalantri, S.P. Accuracy of perception and touch for detecting fever in adults: A hospital-based study from a rural, tertiary hospital in Central India. Trop. Med. Int. Health 2003, 8, 408–414. [Google Scholar] [CrossRef] [PubMed]
- Einterz, E.M.; Bates, M.E. Fever in Africa: Do patients know when they are hot? Lancet 1997, 350, 781. [Google Scholar] [CrossRef]
- Nakitende, I.; Namujwiga, T.; Kellett, J.; Opio, M.; Lumala, A. Patient reported symptoms, body temperature and hospital mortality: An observational study in a low resource healthcare environment. QJM 2018, 111, 691–697. [Google Scholar] [CrossRef]
- Henning, D.J.; Carey, J.R.; Oedorf, K.; Day, D.E.; Redfield, C.S.; Huguenel, C.J.; Roberts, J.C.; Sanchez, L.D.; Wolfe, R.E.; Shapiro, N.I. The Absence of Fever Is Associated With Higher Mortality and Decreased Antibiotic and IV Fluid Administration in Emergency Department Patients With Suspected Septic Shock. Crit. Care Med. 2017, 45, e575–e582. [Google Scholar] [CrossRef]
- Kushimoto, S.; Abe, T.; Ogura, H.; Shiraishi, A.; Saitoh, D.; Fujishima, S.; Mayumi, T.; Hifumi, T.; Shiino, Y.; Nakada, T.-A.; et al. JAAM Focused Outcome Research on Emergency Care for Acute respiratory distress syndrome, Sepsis and Trauma (FORECAST) Group. Impact of Body Temperature Abnormalities on the Implementation of Sepsis Bundles and Outcomes in Patients With Severe Sepsis: A Retrospective Sub-Analysis of the Focused Outcome Research on Emergency Care for Acute Respiratory Distress Syndrome, Sepsis and Trauma Study. Crit. Care Med. 2019, 47, 691–699. [Google Scholar]
- Laupland, K.B.; Zahar, J.-R.; Adrie, C.; Schwebel, C.; Goldgran-Toledano, D.; Azoulay, E.; Garrouste-Orgeas, M.; Cohen, Y.; Jamali, S.; Souweine, B.; et al. Determinants of temperature abnormalities and influence on outcome of critical illness. Crit. Care Med. 2012, 40, 145–151. [Google Scholar] [CrossRef]
- Young, P.J.; Saxena, M.; Beasley, R.; Bellomo, R.; Bailey, M.; Pilcher, D.; Finfer, S.; Harrison, D.; Myburgh, J.; Rowan, K. Early peak temperature and mortality in critically ill patients with or without infection. Intensive Care Med. 2012, 38, 437–444. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Bota, D.P.; Ferreira, F.L.; Mélot, C.; Vincent, J.L. Body temperature alterations in the critically ill. Intensive Care Med. 2004, 30, 811–816. [Google Scholar] [CrossRef]
- Sundén-Cullberg, J.; Rylance, R.; Svefors, J.; Norrby-Teglund, A.; Björk, J.; Inghammar, M. Fever in the Emergency Department Predicts Survival of Patients With Severe Sepsis and Septic Shock Admitted to the ICU. Crit. Care Med. 2017, 45, 591–599. [Google Scholar] [CrossRef]
- Marcusohn, E.; Gibory, I.; Miller, A.; Lipsky, A.M.; Neuberger, A.; Epstein, D. The association between the degree of fever as measured in the emergency department and clinical outcomes of hospitalized adult patients. Am. J. Emerg. Med. 2021, 52, 92–98. [Google Scholar] [CrossRef]
- Malinovska, A.; Pitasch, L.; Geigy, N.; Nickel, C.H.; Bingisser, R. Modification of the Emergency Severity Index Improves Mortality Prediction in Older Patients. West J. Emerg. Med. 2019, 20, 633–640. [Google Scholar] [CrossRef]
- Bingisser, R.; Nickel, C.H. The last decade of symptom-oriented research in emergency medicine: Triage, work-up, and disposition. Swiss Med. Wkly. 2019, 149, w20141. [Google Scholar] [CrossRef]
- Rueegg, M.; Nickel, C.H.; Bingisser, R. Disagreements between emergency patients and physicians regarding chief complaint—Patient factors and prognostic implications. Int. J. Clin. Pract. 2021, 75, e14070. [Google Scholar] [CrossRef]
- Grossmann, F.F.; Nickel, C.H.; Christ, M.; Schneider, K.; Spirig, R.; Bingisser, R. Transporting clinical tools to new settings: Cultural adaptation and validation of the Emergency Severity Index in German. Ann. Emerg. Med. 2011, 57, 257–264. [Google Scholar] [CrossRef]
- Williams, B.; Alberti, G.; Ball, C.; Ball, D.; Binks, R.; Durham, L. National Early Warning Score (NEWS): Standardising the Assessment of Acute-Illness Severity in the NHS; Royal College of Physicians: London, UK, 2012. [Google Scholar]
- Schmid, F.; Malinovska, A.; Weigel, K.; Bosia, T.; Nickel, C.H.; Bingisser, R. Construct validity of acute morbidity as a novel outcome for emergency patients. PLoS ONE 2019, 14, e0207906. [Google Scholar]
- Yamamoto, S.; Yamazaki, S.; Shimizu, T.; Takeshima, T.; Fukuma, S.; Yamamoto, Y.; Tochitani, K.; Tsuchido, Y.; Shinohara, K.; Fukuhara, S. Body Temperature at the Emergency Department as a Predictor of Mortality in Patients with Bacterial Infection. Medicine 2016, 95, e3628. [Google Scholar] [CrossRef]
- Shimazui, T.; Nakada, T.-A.; Walley, K.R.; Oshima, T.; Abe, T.; Ogura, H.; Shiraishi, A.; Kushimoto, S.; Saitoh, D.; Fujishima, S.; et al. JAAM FORECAST Group. Significance of body temperature in elderly patients with sepsis. Crit. Care 2020, 24, 387. [Google Scholar] [CrossRef]
- Soysal, P.; Kara, O. Delirium as the first clinical presentation of the coronavirus disease 2019 in an older adult. Psychogeriatrics 2020, 20, 763–765. [Google Scholar] [CrossRef]
- de Souza Martins, F.; Guedes, G.G.; Santos, T.M.; de Carvalho-Filho, M.A. Suspected infection in afebrile patients: Are they septic? Medicine 2017, 96, e6299. [Google Scholar] [CrossRef]
- Leung, C. Risk factors for predicting mortality in elderly patients with COVID-19: A review of clinical data in China. Mech. Ageing Dev. 2020, 188, 111255. [Google Scholar] [CrossRef]
- Silva, L.O.J.E.; Berning, M.J.; Stanich, J.A.; Gerberi, D.J.; Murad, M.H.; Han, J.H.; Bellolio, F. Risk Factors for Delirium in Older Adults in the Emergency Department: A Systematic Review and Meta-Analysis. Ann. Emerg. Med. 2021, 78, 549–565. [Google Scholar] [CrossRef]
Total | No Fever Symptoms | Fever Symptoms | p-Value | |
---|---|---|---|---|
n = 2183 | n = 1858 | n = 325 | ||
Age, median (IQR) (years) | 56.0 (37.0; 75.0) | 57.0 (37.0; 76.0) | 53.0 (33.0; 70.0) | 0.001 |
Female Sex, n (%) | 1124 (51.5%) | 967 (52.0%) | 157 (48.3%) | 0.23 |
Temperature, median (IQR) (°C) | 36.9 (36.5; 37.5) | 36.8 (36.4; 37.2) | 38.1 (37.3; 38.8) | <0.001 |
ESI Triage Category, n (%) | 0.45 | |||
1 | 29 (1.3%) | 28 (1.5%) | 1 (0.3%) | |
2 | 588 (27.0%) | 502 (27.1%) | 86 (26.5%) | |
3 | 1071 (49.1%) | 912 (49.2%) | 159 (48.9%) | |
4 | 470 (21.6%) | 394 (21.2%) | 76 (23.4%) | |
5 | 22 (1.0%) | 19 (1.0%) | 3 (0.9%) | |
Missing | 3 | 3 (0.2%) | 0 (0%) | |
European, n (%) | 1522 (69.9%) | 1332 (71.9%) | 190 (58.5%) | <0.001 |
Acute Morbidity, n (%) | 1021 (46.8%) | 850 (45.7%) | 171 (52.6%) | 0.03 |
Hospitalization, n (%) | 905 (41.5%) | 744 (40.0%) | 161 (49.5%) | 0.002 |
Intensive Care Admission, n (%) | 149 (6.8%) | 132 (7.1%) | 17 (5.2%) | 0.26 |
In-hospital Mortality, n (%) | 33 (1.5%) | 32 (1.7%) | 1 (0.3%) | 0.05 |
Normal Temperature | High Temperature | Low Temperature | p-Value | |
---|---|---|---|---|
n = 1713 | n = 252 | n = 218 | ||
Age, median (IQR) (years) | 55.0 (35.0; 74.0) | 59.0 (35.0; 77.0) | 65.0 (44.2; 77.0) | 0.002 |
Female Sex, n (%) | 919 (53.6%) | 108 (42.9%) | 97 (44.5%) | 0.001 |
Temperature, median (IQR) (°C) | 36.9 (36.6; 37.3) | 38.7 (38.3; 39.1) | 35.9 (35.5; 36.0) | <0.001 |
ESI Triage Category, n (%) | ||||
1 | 17 (1.0%) | 3 (1.2%) | 9 (4.1%) | |
2 | 429 (25.1%) | 87 (34.5%) | 72 (33.0%) | |
3 | 857 (50.1%) | 121 (48.0%) | 93 (42.7%) | |
4 | 390 (22.8%) | 39 (15.5%) | 41 (18.8%) | |
5 | 17 (1.0%) | 2 (0.8%) | 3 (1.4%) | |
Missing | 3 | 0 | 0 | |
European, n (%) | 524 (30.7%) | 80 (31.7%) | 51 (23.4%) | 0.072 |
Acute Morbidity, n (%) | 762 (44.5%) | 148 (58.7%) | 111 (50.9%) | <0.001 |
Hospitalization, n (%) | 666 (38.9%) | 148 (58.7%) | 91 (41.7%) | <0.001 |
Intensive Care Admission, n (%) | 109 (6.4%) | 19 (7.5%) | 21 (9.6%) | 0.176 |
In-hospital Mortality, n (%) | 23 (1.3%) | 2 (0.8%) | 8 (3.7%) | 0.033 |
Concordance | Discordance | p-Value | |||
---|---|---|---|---|---|
Perceived Fever | No | Yes | No | Yes | |
Temperature | Normal | Altered | Altered | Normal | |
Number | n = 1566 | n = 178 | n = 292 | n = 147 | |
Age, median (IQR) (years) | 55.0 (36.0; 75.0) | 54.5 (32.2; 72.0) | 66.0 (44.8; 80.0) | 47.0 (33.0; 66.5) | <0.001 |
Female Sex, n (%) | 839 (53.6%) | 77 (43.3%) | 128 (43.8%) | 80 (54.4%) | |
Temperature, median (IQR) (°C) | 36.9 (36.5; 37.2) | 38.8 (38.3; 39.1) | 36.0 (35.7; 38.1) | 37.3 (36.8; 37.8) | <0.001 |
ESI Triage Category, n (%) | |||||
1 | 17 (1.09%) | 1 (0.56%) | 11 (3.77%) | 0 (0.00%) | |
2 | 402 (25.7%) | 59 (33.1%) | 100 (34.2%) | 27 (18.4%) | |
3 | 781 (50.0%) | 83 (46.6%) | 131 (44.9%) | 76 (51.7%) | |
4 | 347 (22.2%) | 33 (18.5%) | 47 (16.1%) | 43 (29.3%) | |
5 | 16 (1.02%) | 2 (1.12%) | 3 (1.03%) | 1 (0.68%) | |
Missing | 3 | 0 | 3 | 0 | |
European, n (%) | 1101 (70.6%) | 108 (60.7%) | 231 (79.1%) | 82 (55.8%) | <0.001 |
Acute Morbidity, n (%) | 685 (43.7%) | 94 (52.8%) | 165 (56.5%) | 77 (52.4%) | <0.001 |
Hospitalization, n (%) | 601 (38.4%) | 96 (53.9%) | 143 (49.0%) | 65 (44.2%) | <0.001 |
Intensive Care Admission, n (%) | 102 (6.51%) | 10 (5.62%) | 30 (10.3%) | 7 (4.76%) | 0.07 |
In-hospital Mortality, n (%) | 23 (1.47%) | 1 (0.56%) | 9 (3.08%) | 0 (0.00%) | 0.06 |
Performance Test of Patients’ History Metric | Value | 95% Confidence Interval |
---|---|---|
fever prevalence | 21.3 | |
sensitivity | 36.4% | 32.1–40.8% |
specificity | 91.5% | 90.1–92.7 |
positive predictive value | 53.7% | 48.2–59.1 |
negative predictive value | 84.1% | 82.4–85.7 |
positive likelihood ratio | 4.2 | 3.5–5.2 |
negative likelihood ratio | 0.7 | 0.6–0.7 |
Discordance of Perceived Fever and Measurement | ||||||
---|---|---|---|---|---|---|
Crude | Adjusted † | |||||
Outcome | Odds Ratio | 95% CI | p-Value | Odds Ratio | 95% CI | p-Value |
Acute Morbidity | 1.52 | 1.23–1.88 | <0.001 | 1.71 | 1.2–2.44 | 0.003 |
Hospitalization | 1.35 | 1.1–1.67 | 0.005 | 1.56 | 1.13–2.15 | 0.007 |
Intensive Care Admission | 1.34 | 0.91–1.98 | 0.14 | 1.12 | 0.64–1.96 | 0.69 |
In-hospital-Mortality | 1.5 | 0.69–3.25 | 0.30 | -- | -- | -- |
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Malinovska, A.; Malinovska, L.; Nickel, C.H.; Bingisser, R. Prevalence and Prognosis of Fever Symptoms, Hypo-, and Hyperthermia in Unselected Emergency Patients. J. Clin. Med. 2022, 11, 24. https://doi.org/10.3390/jcm11010024
Malinovska A, Malinovska L, Nickel CH, Bingisser R. Prevalence and Prognosis of Fever Symptoms, Hypo-, and Hyperthermia in Unselected Emergency Patients. Journal of Clinical Medicine. 2022; 11(1):24. https://doi.org/10.3390/jcm11010024
Chicago/Turabian StyleMalinovska, Alexandra, Liliana Malinovska, Christian H. Nickel, and Roland Bingisser. 2022. "Prevalence and Prognosis of Fever Symptoms, Hypo-, and Hyperthermia in Unselected Emergency Patients" Journal of Clinical Medicine 11, no. 1: 24. https://doi.org/10.3390/jcm11010024
APA StyleMalinovska, A., Malinovska, L., Nickel, C. H., & Bingisser, R. (2022). Prevalence and Prognosis of Fever Symptoms, Hypo-, and Hyperthermia in Unselected Emergency Patients. Journal of Clinical Medicine, 11(1), 24. https://doi.org/10.3390/jcm11010024