Human temperatures for syndromic surveillance in the emergency department: data from the autumn wave of the 2009 swine flu (H1N1) pandemic and a seasonal influenza outbreak

Abstract

BackgroundThe emergency department (ED) increasingly acts as a gateway to the evaluation and treatment of acute illnesses. Consequently, it has also become a key testing ground for systems that monitor and identify outbreaks of disease. Here, we describe a new technology that automatically collects body temperatures during triage. The technology was tested in an ED as an approach to monitoring diseases that cause fever, such as seasonal flu and some pandemics.MethodsTemporal artery thermometers that log temperature measurements were placed in a Boston ED and used for initial triage vital signs. Time-stamped measurements were collected from the thermometers to investigate the performance a real-time system would offer. The data were summarized in terms of rates of fever (temperatures ≥100.4 °F [≥38.0 °C]) and were qualitatively compared with regional disease surveillance programs in Massachusetts.ResultsFrom September 2009 through August 2011, 71,865 body temperatures were collected and included in our analysis, 2073 (2.6 %) of which were fevers. The period of study included the autumn–winter wave of the 2009–2010 H1N1 (swine flu) pandemic, during which the weekly incidence of fever reached a maximum of 5.6 %, as well as the 2010–2011 seasonal flu outbreak, during which the maximum weekly incidence of fever was 6.6 %. The periods of peak fever rates corresponded with the periods of regionally elevated flu activity.ConclusionsTemperature measurements were monitored at triage in the ED over a period of 2 years. The resulting data showed promise as a potential surveillance tool for febrile disease that could complement current disease surveillance systems. Because temperature can easily be measured by non-experts, it might also be suitable for monitoring febrile disease activity in schools, workplaces, and transportation hubs, where many traditional syndromic indicators are impractical. However, the system’s validity and generalizability should be evaluated in additional years and settings.Electronic supplementary materialThe online version of this article (doi:10.1186/s12873-016-0080-7) contains supplementary material, which is available to authorized users.

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

“…14,15 The Boston data were initially collected to assess fever incidence as a means of tracking disease outbreaks (syndromic surveillance). 16 We also observed that mean body temperature followed a consistent diurnal cycle across days of the week and seasons of the year in the Boston ED. 17 These results suggested that it would be useful to study how body temperature cycles relate to fever presentation.…”

A Proof Of Concept For A Syndromic Surveillance System Based On Routine Ambulance Records In The South-west Of England, For The Influenza Season 2016/17

“…A cohort study conducted by Obermeyer et al (2017) [17] in 35,488 healthy patients confirmed the daily variation and found a normal range of 35.3-37.7 • C. This study also established a negligible discrepancy of -0.03 • C of tympanic versus oral temperature [17]. Therefore, temperatures between >37.7-42 • C, were considered as pyrexia where the upper cut-off accounts for hyperpyrexia [7]. The analysis was performed on records of patients with tympanic temperature readings within the range of 32-42 • C. This excluded 0.0306% of the records (i.e.…”

“…Both devices have a measurement range of 34-42.2 • C with an accuracy of 0.2 • C between 35.5-42 • C and 0.3 • C outside this range [12,13]. As the data included temperature readings outside the range of the device capabilities, records indicating physiological hypothermia (32 • C) [14,15] and hyperpyrexia (42 • C) [7] were excluded.…”

“…In the past, temperature screening has been applied during outbreaks of infectious diseases such as the Severe Acute Respiratory Syndrome (SARS) [4][5][6] and was routinely used to identify carriers at airports. It has also been demonstrated that the monitoring of body temperature on its own, allowed to detect an outbreak of seasonal flu in an emergency department in Boston (US) [7].…”

Fevers Are Rarer in the Morning—Could We Be Missing Infectious Disease Cases by Screening for Fever Then?

“…Methods: Temperatures (n=115,149) were collected during triages at a Boston adult emergency department to monitor outbreaks (September 2009-March 2012). 2,3 We also investigated adult triage temperatures (n=218,574) from a nationally representative study of US emergency department visits (December 2002-December 2010). 4 The thermometer types used were temporal artery (Boston) and a nationally representative sample (national).…”