Emergency department rectal temperatures in over 10 years:A retrospective observational study

摘要

BACKGROUND:Fever in patients can provide an important clue to the etiology of a patient’s symptoms.Non-invasive temperature sites(oral,axillary,temporal) may be insensitive due to a variety of factors.This has not been well studied in adult emergency department patients.To determine whether emergency department triage temperatures detected fever adequately when compared to a rectal temperature.METHODS:A retrospective chart review was made of 27 130 adult patients in a high volume,urban emergency department over an eight-year period who received first a non-rectal triage temperature and then a subsequent rectal temperature.RESULTS:The mean difference in temperatures between the initial temperature and the rectal temperature was 1.3 °F(P<0.001),with 25.9%of the patients having higher rectal temperatures >2°F,and 5.0%having higher rectal temperatures >4 °F.The mean difference among the patients who received oral,axillary,and temporal temperatures was 1.2 °F(PO.001),1.8 °F(PO.001),and 1.2 °F(P<0.001) respectively.About 18.1%of the patients were initially afebrile and found to be febrile by rectal temperature,with an average difference of 2.5 °F(P<0.001).These patients had a higher rate of admission(61.4%,P<0.005),and were more likely to be admitted to the hospital for a higher level of care,such as an intensive care unit,when compared with the full cohort(12.5%vs.5.8%,P<0.005).CONCLUSIONS:There are significant differences between rectal temperatures and noninvasive triage temperatures in this emergency department cohort.In almost one in five patients,fever was missed by triage temperature.