Marco C A, Schoenfeld C N, Hansen K N, Hexter D A, Stearns D A, Kelen G D
Department of Emergency Medicine, Johns Hopkins Bayview Medical Center, Baltimore, Maryland, USA.
Ann Emerg Med. 1995 Jul;26(1):18-24. doi: 10.1016/s0196-0644(95)70232-6.
To determine the clinical significance of fever in geriatric emergency department patients.
Case series with follow-up.
Urban, university-affiliated community hospital.
Consecutive patients over the age of 65 years who presented to the ED during a 12-month period with an oral temperature of 100.0 degrees F (37.8 degrees C) or higher.
We considered the following features indicators of serious illness: positive blood culture(s), related death within 1 month of ED visit, need for surgery or other invasive procedure, hospitalization for 4 or more days, IV antibiotics for 3 or more days, and repeat ED visit within 72 hours for related condition. Four hundred eighty-nine patients were eligible for study. Of the 470 patients with complete follow-up data, 357 (76.0%) had indicators of serious illness. Clinical features found to be independently associated with serious illness included oral temperature of 103 degrees F (39.4 degrees C) or more, respiration rate of 30 or more, leukocytosis of 11.0 x 10(9)/L or more, presence of an infiltrate, and pulse of 120 or more. At least one indicator of serious illness was present in 63 of 128 patients (49.6%) with none of these independently predictive clinical features. The most common final diagnoses were pneumonia (24.0%), urinary-tract infection (21.7%), and sepsis (12.8%).
Fever among geriatric ED patients frequently marks the presence of serious illness. All such patients should be strongly considered for hospital admission, particularly when certain clinical features are present. The absence of abnormal findings does not reliably rule out the possibility of serious illness.
确定老年急诊科患者发热的临床意义。
随访病例系列研究。
城市中与大学相关的社区医院。
在12个月期间，年龄在65岁及以上，到急诊科就诊时口腔温度达到100.0华氏度（37.8摄氏度）或更高的连续患者。
我们将以下特征视为严重疾病的指标：血培养阳性、急诊就诊后1个月内相关死亡、需要手术或其他侵入性操作、住院4天或更长时间、静脉使用抗生素3天或更长时间，以及因相关病情在72小时内再次到急诊科就诊。489名患者符合研究条件。在470名有完整随访数据的患者中，357名（76.0%）有严重疾病的指标。发现与严重疾病独立相关的临床特征包括口腔温度达到103华氏度（39.4摄氏度）或更高、呼吸频率30次或更多、白细胞计数11.0×10⁹/L或更高、存在浸润影以及脉搏120次或更多。在128名没有这些独立预测临床特征的患者中，有63名（49.6%）至少有一项严重疾病的指标。最常见的最终诊断是肺炎（24.0%）、尿路感染（21.7%）和败血症（12.8%）。
老年急诊科患者的发热常常标志着存在严重疾病。所有这类患者都应被强烈考虑收住入院，尤其是当出现某些临床特征时。没有异常发现并不能可靠地排除严重疾病的可能性。
