Malinovska Alexandra, Malinovska Liliana, Nickel Christian H, Bingisser Roland
Department of Emergency Medicine, University Hospital Basel, 4031 Basel, Switzerland.
Department of Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA.
J Clin Med. 2021 Dec 22;11(1):24. doi: 10.3390/jcm11010024.
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.
对病史和体温的评估是所有前往急诊科（ED）就诊患者诊断检查的基石。然而，体温的客观测量与发热的主观感受可能存在差异。这是一项在瑞士一家成人急诊科进行的连续全人群研究的二次探索性分析。如果患者存在发热情况，经过培训的医学生对所有患者进行访谈。使用耳温计在分诊时测量的体温异常（>38.0℃/<36.0℃）作为诊断性能的参考标准。如果发热症状与体温异常不一致，则记录为不相符。从电子健康记录中提取病例严重程度的结局指标（急性发病率、住院治疗、重症监护和院内死亡率）。计算体征和症状与结局不相符的比值比（OR）。在2183例患者中，325例患者报告有发热症状。发热症状作为体温异常检测方法的敏感性为36.3%。特异性为91.5%。阴性预测值为84.1%，阳性似然比为4.2，阴性似然比为0.7。发热症状与体温异常不相符的校正OR值，急性发病率为1.71（95%CI：1.2 - 2.44），住院治疗为1.56（95%CI：1.13 - 2.15），重症监护为1.12（95%CI：0.64 - 1.59）。死亡率的未校正OR值为1.5（95%CI：0.69 - 3.25）。发热症状与体温异常大致重叠，但可根据体征和症状的一致性进行分层。在不一致的情况下，急性发病率和住院治疗的几率会增加。因此，不相符情况可作为严重结局的警示信号进一步研究。
