Departments of Pediatrics.
Medicine, Quantitative Sciences Unit, School of Medicine, Stanford University, Stanford, California.
Pediatrics. 2022 Jan 1;149(1). doi: 10.1542/peds.2021-053412.
To determine the (1) frequency and visit characteristics of routine temperature measurement and (2) rates of interventions by temperature measurement practice and the probability of incidental fever detection.
In this retrospective cohort study, we analyzed well-child visits between 2014-2019. We performed multivariable regression to characterize visits associated with routine temperature measurement and conducted generalized estimating equations regression to determine adjusted rates of interventions (antibiotic prescription, and diagnostic testing) and vaccine deferral by temperature measurement and fever status, clustered by clinic and patient. Through dual independent chart review, fever (≥100.4°F) was categorized as probable, possible, or unlikely to be incidentally detected.
Temperature measurement occurred at 155 527 of 274 351 (58.9%) well-child visits. Of 24 clinics, 16 measured temperature at >90% of visits ("routine measurement clinics") and 8 at <20% of visits ("occasional measurement clinics"). After adjusting for age, ethnicity, race, and insurance, antibiotic prescription was more common (adjusted odds ratio: 1.21; 95% CI 1.13-1.29), whereas diagnostic testing was less common (adjusted odds ratio: 0.76; 95% CI 0.71-0.82) at routine measurement clinics. Fever was detected at 270 of 155 527 (0.2%) routine measurement clinic visits, 47 (17.4%) of which were classified as probable incidental fever. Antibiotic prescription and diagnostic testing were more common at visits with probable incidental fever than without fever (7.4% vs 1.7%; 14.8% vs 1.2%; P < .001), and vaccines were deferred at 50% such visits.
Temperature measurement occurs at more than one-half of well-child visits and is a clinic-driven practice. Given the impact on subsequent interventions and vaccine deferral, the harm-benefit profile of this practice warrants consideration.
确定（1）常规体温测量的频率和就诊特征，以及（2）体温测量实践的干预率和偶然发热检出率。
本回顾性队列研究分析了 2014 年至 2019 年的儿童保健就诊情况。我们采用多变量回归分析来描述与常规体温测量相关的就诊情况，并通过广义估计方程回归分析来确定体温测量和发热状态下的干预率（抗生素处方和诊断性检查）和疫苗延迟接种率，这些数据按诊所和患者进行聚类。通过双重独立的图表审查，将发热（≥100.4°F）分为可能、可能或不太可能偶然发现。
在 274351 次儿童保健就诊中，有 155527 次进行了体温测量。在 24 家诊所中，有 16 家诊所（“常规测量诊所”）的就诊中有超过 90%进行了体温测量，而 8 家诊所（“偶测诊所”）的就诊中只有不到 20%进行了体温测量。在调整年龄、种族、民族和保险后，常规测量诊所的抗生素处方更为常见（调整后的优势比：1.21；95%置信区间：1.13-1.29），而诊断性检查则更为少见（调整后的优势比：0.76；95%置信区间：0.71-0.82）。在 155527 次常规测量诊所就诊中，有 270 次发现发热，其中 47 次（17.4%）被归类为可能偶然发热。与无发热就诊相比，偶然发热就诊更可能使用抗生素（7.4% vs 1.7%；P<0.001）和接受诊断性检查（14.8% vs 1.2%；P<0.001），并且有 50%的偶然发热就诊推迟了疫苗接种。
体温测量在超过一半的儿童保健就诊中进行，这是一种诊所驱动的做法。鉴于对后续干预和疫苗延迟接种的影响，这种做法的利弊值得考虑。
