Warnock Clare, Totterdell Peter, Tod Angela Mary, Mead Rachel, Gynn Jamie-Lee, Hancock Barry
Weston Park Hospital, Specialist Cancer Services, Sheffield Teaching Hospitals NHS Foundation Trust, Witham Road, Sheffield, S10 2SJ, UK.
University of Sheffield, Cathedral Court, 1, Vicar Lane, Sheffield, S1 2LT, UK.
Eur J Oncol Nurs. 2018 Dec;37:12-18. doi: 10.1016/j.ejon.2018.10.001. Epub 2018 Oct 21.
The primary aim of this study was to examine the value of temperature as a diagnostic and prognostic indicator of infection and sepsis in neutropenic patients. A secondary aim was to gain insight into the presenting symptoms reported by these patients at home or on their initial admission assessment.
A cohort study was carried out using a case note review of 220 emergency admissions to a regional cancer centre. All participants were neutropenic and were diagnosed with infection on admission. The main outcome measures were relationships between Early Warning Scores and temperature values at home, on admission and during the hospital stay.
22% of patients who became acutely unwell did not have a fever. Pearson correlations showed only small associations between highest temperature value at any time point and highest early warning scores (r(202) = 0.176, P = .012). Temperature at home (B = 0.156, P = .336) and temperature on admission (B = 0.200, P = .052) did not predict highest Early Warning Scores.
Body temperature is not a consistently reliable diagnostic or prognostic indicator for outcomes in patients with neutropenia and symptoms of infection. It can assist with early presentation and recognition of infection in many neutropenic patients. However, over-reliance on temperature risks missing the opportunity for early detection and treatment.
本研究的主要目的是检验体温作为中性粒细胞减少患者感染和脓毒症诊断及预后指标的价值。次要目的是深入了解这些患者在居家或初次入院评估时报告的症状表现。
采用病例记录回顾法，对一家地区癌症中心220例急诊入院患者进行队列研究。所有参与者均为中性粒细胞减少症患者，入院时被诊断为感染。主要观察指标是早期预警评分与患者居家时、入院时及住院期间体温值之间的关系。
22%病情急性恶化的患者没有发热。Pearson相关性分析显示，任何时间点的最高体温值与最高早期预警评分之间仅有微弱关联（r(202) = 0.176，P = .012）。居家体温（B = 0.156，P = .336）和入院体温（B = 0.200，P = .052）均不能预测最高早期预警评分。
体温并非中性粒细胞减少且有感染症状患者预后的始终可靠的诊断或预后指标。它可帮助许多中性粒细胞减少患者早期就诊和识别感染。然而，过度依赖体温有错过早期检测和治疗机会的风险。
