Top ‘Normal’ Temperature May Be Lower Than Current Standard

Top ‘Normal’ Temperature May Be Lower Than Current Standard

(Reuters Health) – The normal range of temperatures in uninfected hospitalized patients lies between 95.8 and 99.9 degrees Fahrenheit, a new study suggests.

An analysis of nearly 496,000 temperature readings from more than 42,000 inpatients without malignancy, infection or immune dysfunction, revealed that the threshold for fever might be half a degree lower than the current cutoff of 100.4 degrees F (38 degrees Celsius), researchers report in JAMA.

“To the extent that clinicians are going to use a temperature cutoff for working up a patient with a fever we need to be aware that patients who are infected may have temperatures below 100.4,” said Dr. Michael Rothberg, vice chair for research at Cleveland Clinic Community Care, in Ohio. “This wasn’t completely surprising since the same thing has been observed in the outpatient setting. It just hasn’t really penetrated the way we practice in hospitals.”

To get a better sense of what the “normal” temperature range would be in an inpatient setting, Dr. Rothberg and his colleagues collected health record data from nonsurgical patients hospitalized within the Cleveland Clinic Health System in 2017-2018.

The researchers excluded patients with evidence of malignancy, infection, or immunological dysfunction, which were identified through diagnosis codes, medications, or laboratory tests. The 42,622 patients in the study were hospitalized for a variety of diagnoses, including acute heart failure, shock, myocardial infarction, kidney disease, poisoning and gastrointestinal bleeding.

Patients whose measurements were included in the study had a mean age of 61, 50% were female, 68% were white, 25% were Black and the mean BMI was 30 kg/m2.

Included in the analysis were 495,886 oral temperatures measured during the first week of patients’ hospitalization. The patients’ temperatures ranged from 95.8 to 99.9 degrees F (35.44 to 37.72 degrees C) and the mean temperature was 98.04 degrees F (36.69 degrees C). Temperatures were lower among patients who were older and were higher in patients who were female, Black or pregnant.

The authors note that the current cutoff temperature of 100.4 F dates back to the 1860s and is based on axillary temperatures.

The new paper is “so interesting,” said Dr. Allison DeKosky, an assistant professor of medicine and director of quality initiatives for hospital medicine at UPMC. “It’s great that they have information from 42,000 or so patients, but it’s only at a single site so it’s hard to make generalized statements about it.”

“It was also interesting to learn that the current number was based on axillary temperature studies from the 1860s,” Dr. DeKosky said.

The new study is “a great proof of concept,” Dr. DeKosky said. “But I don’t think it will change practice. It’s an interesting first step.”

The findings are “important because there is no universally consistent definition of fever,” said Dr. Erik Blutinger, an emergency medicine physician at Mount Sinai Queens, in New York City. “So it’s helpful to have a barometer of what temperature we should be concerned about clinically.”

“It’s not a perfect study and we still need to learn a lot about the presence of fever,” Dr. Blutinger said.

SOURCE: JAMA, online May 11, 2021.

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