Ames Nancy J, Powers John H, Ranucci Alexandra, Gartrell Kyungsook, Yang Li, VanRaden Mark, Leidy Nancy Kline, Wallen Gwenyth R
Clinical Center, National Institutes of Health, Bldg 10 Rm 2B-10, 10 Center Drive, Bethesda, MD, 20892, USA.
Clinical Research Directorate/Clinical Monitoring Research Program, Leidos Biomedical Research, Inc., NCI Campus at Frederick, Frederick, Maryland, 21702, USA.
Health Qual Life Outcomes. 2017 Apr 27;15(1):84. doi: 10.1186/s12955-017-0644-6.
Although body temperature is one of four key vital signs routinely monitored and treated in clinical practice, relatively little is known about the symptoms associated with febrile states. The purpose of this study was to assess the validity, reliability and feasibility of the Fever Assessment Tool (FAST) in an acute care research setting.
Qualitative: To assess content validity and finalize the FAST instrument, 12 adults from an inpatient medical-surgical unit at the National Institutes of Health (NIH) Clinical Center participated in cognitive interviews within approximately 12 h of a febrile state (tympanic temperature ≥ 38° Celsius). Quantitative: To test reliability, validity and feasibility, 56 new adult inpatients completed the 21-item FAST.
The cognitive interviews clarified and validated the content of the final 21-item FAST. Fifty-six patients completed the FAST from two to 133 times during routine vital sign assessment, yielding 1,699 temperature time points. Thirty-four percent of the patients (N = 19) experienced fever at one or more time points, with a total of 125 febrile time points. Kuder-Richardson 20 (KR-20) reliability of the FAST was 0.70. Four nonspecific symptom categories, Tired or Run-Down (12), Sleepy (13), Weak or Lacking Energy (11), and Thirsty (9) were among the most frequently reported symptoms in all participants. Using Generalized Estimating Equations (GEE), the odds of reporting eight symptoms, Warm (4), Sweating (5), Thirsty (9), General Body Aches (10), Weak or Lacking Energy (11), Tired or Run Down (12) and Difficulty Breathing (17), were increased when patients had a fever (Fever Now), compared to the two other subgroups-patients who had a fever, but not at that particular time point, (Fever Not Now) and patients who never had a fever (Fever Never). Many, but not all, of the comparisons were significant in both groups.
Results suggest the FAST is reliable, valid and easy to administer. In addition to symptoms usually associated with fever (e.g. feeling warm), symptoms such as Difficulty Breathing (17) were identified with fever. Further study in a larger, more diverse patient population is warranted.
Clinical Trials Number: NCT01287143 (January 2011).
尽管体温是临床实践中常规监测和治疗的四项关键生命体征之一，但对于发热状态相关的症状却知之甚少。本研究的目的是评估发热评估工具（FAST）在急性护理研究环境中的有效性、可靠性和可行性。
定性研究：为评估内容效度并确定FAST工具，来自美国国立卫生研究院（NIH）临床中心内科-外科住院部的12名成年人在发热状态（鼓膜温度≥38摄氏度）后约12小时内参与了认知访谈。定量研究：为测试可靠性、有效性和可行性，56名新入院的成年患者完成了包含21个条目的FAST。
认知访谈明确并验证了最终包含21个条目的FAST的内容。56名患者在常规生命体征评估期间完成FAST的次数从2次到133次不等，共产生了1699个体温时间点。34%的患者（N = 19）在一个或多个时间点出现发热，共有125个发热时间点。FAST的库德-理查森20（KR-20）信度为0.70。在所有参与者中，四个非特异性症状类别，即疲倦或虚弱（12）、困倦（13）、虚弱或缺乏精力（11）和口渴（9）是报告频率最高的症状。使用广义估计方程（GEE），与另外两个亚组相比，即发热但并非在该特定时间点的患者（非当前发热）和从未发热的患者（从未发热），当患者发热（当前发热）时，报告八种症状的几率增加，这八种症状分别是发热（4）、出汗（5）、口渴（9）、全身酸痛（10）、虚弱或缺乏精力（11）、疲倦或虚弱（12）和呼吸困难（17）。两组中的许多（但并非全部）比较具有显著性。
结果表明FAST可靠、有效且易于实施。除了通常与发热相关的症状（如感觉发热）外，呼吸困难（17）等症状也与发热有关。有必要在更大、更多样化的患者群体中进行进一步研究。
临床试验编号：NCT01287143（2011年1月）。
