Ability of adult patients to predict absence or presence of fever in an emergency department triage clinic

Abstract

ntroduction: Fever is the most appreciated manifestation of disease which usually raises high therapeutic expectations. Patients seek medical advice because they think they are sick and feverish. If they feel that they are sick but not feverish, they may not seek medical advice. Subjective fever may also be an important clue to further evaluation of the patient. Objective: The aim of this study was to assess the reliability of adult patients to predict absence or presence of fever in Emergency Department triage clinic. Methods: A prospective study of 1241 ambulatory adult patients (above 12 years of age) was carried out over a three-week period. All patients were asked whether or not they had fever or felt they had fever or were running a temperature before oral temperature was taken with an IVAC digital machine. Two sets of temperature readings were taken to define fever as 37.8 o C or greater, and 38.0 o C or greater. Results: The sensitivity and specificity of detecting fever by subjective means was 89.6% and 94.5% for male and 90.0% and 94.8% for female. The accuracy rates were 93.9% and 94.6% respectively. The prevalence of objective fever was 8.7% yielding general positive and negative predictive values of 80.9% and 98.9% with an accuracy rate of 94.2%. Conclusion: The reliability of adult patients attending triage clinic in assessing subjective fever was found to be good. Four out of five of our patients who believed they had a fever were actually found to have an objective temperature increase (38.0 o C or greater). This means that medical staff should take a complaint of subjective fever in our population more seriously.