Evaluation of fever in the emergency department

DeWitt, Sarah; Chavez, Summer; Perkins, Jack; Long, Brit; Koyfman, Alexander

doi:10.1016/j.ajem.2017.08.030

Cited by 45 publications

(26 citation statements)

References 30 publications

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“… 33 We specifically suggest studying sepsis, for which delays in diagnostic maneuvers and management can be especially consequential. 34 Although body temperature can be an unreliable sign in sepsis, 34 sub-fever-range body temperature correlates with less-prompt treatment and much greater mortality in sepsis and septic shock. 35 , 36 For example, among intensive care unit-admitted patients with severe sepsis and septic shock, each 1°C reduction in body temperature was associated with a five percentage-point increase in in-hospital mortality rates, with patients in the highest and lowest temperature brackets having mortality rates of 9% and 50%, respectively.…”

Section: Discussionmentioning

confidence: 99%

Fever Incidence Is Much Lower in the Morning than the Evening: Boston and US National Triage Data

Harding¹,

Pompei

Bordonaro³

et al. 2020

WestJEM

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In this observational study, we evaluated time-of-day variation in the incidence of fever that is seen at triage. The observed incidence of fever could change greatly over the day because body temperatures generally rise and fall in a daily cycle, yet fever is identified using a temperature threshold that is unchanging, such as ≥38.0° Celsius (C) (≥100.4° Fahrenheit [F]). Methods: We analyzed 93,225 triage temperature measurements from a Boston emergency department (ED) (2009-2012) and 264,617 triage temperature measurements from the National Hospital Ambulatory Medical Care Survey (NHAMCS, 2002-2010), making this the largest study of body temperature since the mid-1800s. Boston data were investigated exploratorily, while NHAMCS was used to corroborate Boston findings and check whether they generalized. NHAMCS results are nationally representative of United States EDs. Analyses focused on adults. Results: In the Boston ED, the proportion of patients with triage temperatures in the fever range (≥38.0°C, ≥100.4°F) increased 2.5-fold from morning to evening (7:00-8:59 PM vs 7:00-8:59 AM: risk ratio [RR] 2.5, 95% confidence interval [CI], 2.0-3.3). Similar time-of-day changes were observed when investigating alternative definitions of fever: temperatures ≥39.0°C (≥102.2°F) and ≥40.0°C (≥104.0°F) increased 2.4-and 3.6-fold from morning to evening (7:00-8:59 PM vs 7:00-8:59 AM: RRs [95% CIs] 2.4 [1.5-4.3] and 3.6 [1.5-17.7], respectively). Analyses of adult NHAMCS patients provided confirmation, showing mostly similar increases for the same fever definitions and times of day (RRs [95% CIs] 1.8 [1.6-2.1], 1.9 [1.4-2.5], and 2.8 [0.8-9.3], respectively), including after adjusting for 12 potential confounders using multivariable regression (adjusted RRs [95% CIs] 1.8 [1.5-2.1], 1.8 [1.3-2.4], and 2.7 [0.8-9.2], respectively), in age-group analyses (18-64 vs 65+ years), and in several sensitivity analyses. The patterns observed for fever mirror the circadian rhythm of body temperature, which reaches its highest and lowest points at similar times. Conclusion: Fever incidence is lower at morning triages than at evening triages. High fevers are especially rare at morning triage and may warrant special consideration for this reason. Studies should examine whether fever-causing diseases are missed or underappreciated during mornings, especially for sepsis cases and during screenings for infectious disease outbreaks. The daily cycling of fever incidence may result from the circadian rhythm. [

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Section: Discussionmentioning

confidence: 99%

Fever Incidence Is Much Lower in the Morning than the Evening: Boston and US National Triage Data

Harding¹,

Pompei

Bordonaro³

et al. 2020

WestJEM

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“…25 In addition to being caused by infections, hyperthermia can develop due to changes in the thermoregulatory mechanism due to hypothalamic lesions or activation of inflammatory cascades in patients with CO poisoning. 4,28 Interestingly, increased pressure in the chamber during HBO therapy using the ideal gas law has been suggested to cause hyperthermia. 29 However, the cause of hyperthermia is not always evident in clinical practice.…”

Section: Discussionmentioning

confidence: 99%

The impact of hyperthermia after acute carbon monoxide poisoning on neurological sequelae

et al. 2018

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This study investigated whether hyperthermia within the first 24 h after presentation was associated with long-term neurological outcomes after acute carbon monoxide (CO) poisoning. This retrospective study included 200 patients with acute severe CO poisoning. Hyperthermia (≥ 37.5°C) developed during the first 24 h after presentation in 55 (27.5%) patients, and poor long-term neurological sequelae assessed at 23 months after acute CO poisoning developed in 19.5% of the patients. The incidence of poor long-term neurological outcomes was significantly higher in the hyperthermia group than in the normothermia group. Patients with poor long-term neurological outcomes had higher maximum temperatures than patients with good outcomes. No significant difference was found in the time of hyperthermia onset within the first day according to the neurological outcomes. Hyperthermia (adjusted odds ratio (aOR) 5.009 (95% confidence interval (CI) 1.556–16.126)) and maximum temperature (aOR 2.581 (95% CI 1.098–6.063)) within the first 24 h after presentation to the emergency department were independently associated with poor long-term neurological outcomes. Body temperature measurements, which are easily and noninvasively recorded at the bedside in any facility, help to predict the risk for poor long-term neurological outcomes. This study carefully emphasizes fastidious control of pyrexia, particularly during the early period after acute CO poisoning.

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“…Based on guidelines for the management of febrile illnesses provided by authorities such as the WHO and the Society of Critical Care Medicine and the Infectious Disease Society of America, among others, equivalent rectal temperature of ≥ 38°C or axillary temperatures of ≥ 37.5°C are indicative of fever in both adults and children (Ogoina, 2011). Fever is not only a disease, but also an important clinical manifestation of many diseases (Dewitt et al, 2017). One of the important clinical manifestations of COVID-19 is fever.…”

Section: Fever the Mechanism Of Fevermentioning

confidence: 99%

“…IL-1 represents a family of two agonists (IL-1a and IL-1b) (Conti et al, 2004). Numerous studies have demonstrated the capacity of peripherally administered IL-1a and IL-1b to evoke fever in a variety of species (Kluger, 1991;Dinarello, 1996).…”

Section: Materials Basis Of Fevermentioning

confidence: 99%

Research Progress on Main Symptoms of Novel Coronavirus Pneumonia Improved by Traditional Chinese Medicine

Luo

Liu

et al. 2020

Front. Pharmacol.

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Novel coronavirus (COVID-19) pneumonia has become a major threat to worldwide public health, having rapidly spread to more than 180 countries and infecting over 1.6 billion people. Fever, cough, and fatigue are the most common initial symptoms of COVID-19, while some patients experience diarrhea rather than fever in the early stage. Many herbal medicine and Chinese patent medicine can significantly improve these symptoms, cure the patients experiencing a mild 22form of the illness, reduce the rate of transition from mild to severe disease, and reduce mortality. Therefore, this paper summarizes the physiopathological mechanisms of fever, cough, fatigue and diarrhea, and introduces Chinese herbal medicines (Ephedrae Herba, Gypsum Fibrosum, Glycyrrhizae Radix et Rhizoma, Asteris Radix et Rhizoma, Ginseng Radix et Rhizoma, Codonopsis Radix, Atractylodis Rhizoma, etc.) and Chinese patent medicines (Shuang-huang-lian, Ma-xinggan-shi-tang, etc.) with their corresponding therapeutic effects. Emphasis was placed on their material basis, mechanism of action, and clinical research. Most of these medicines possess the pharmacological activities of anti-inflammatory, antioxidant, antiviral, and immunity-enhancement, and may be promising medicines for the treatment or adjuvant treatment of COVID-19 patients.

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Evaluation of fever in the emergency department

Cited by 45 publications

References 30 publications

Fever Incidence Is Much Lower in the Morning than the Evening: Boston and US National Triage Data

Fever Incidence Is Much Lower in the Morning than the Evening: Boston and US National Triage Data

The impact of hyperthermia after acute carbon monoxide poisoning on neurological sequelae

Research Progress on Main Symptoms of Novel Coronavirus Pneumonia Improved by Traditional Chinese Medicine

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