Racial Differences in Temporal Thermometry and Association with Delayed Sepsis Bundle Care

Area of Science:

• Medical Devices
• Clinical Informatics
• Health Equity

Background:

• Accurate temperature monitoring is critical for early sepsis diagnosis.
• Concerns exist regarding the accuracy of temporal artery (forehead) thermometers across different racial and ethnic groups.
• Disparities in sepsis identification and management may be linked to thermometry inaccuracies.

Purpose of the Study:

• To evaluate the performance of temporal artery thermometry across diverse racial and ethnic populations.
• To assess the impact of potential temporal thermometry inaccuracies on the initiation of the sepsis management bundle (SEP-1).

Main Methods:

• Retrospective cohort study analyzing electronic health records from 123 U.S. hospitals (2008-2024).
• Included patients with paired temporal and oral/core temperature measurements within one hour.
• Defined 'hidden fever' and 'hidden hypothermia' based on discrepancies between temporal and core measurements.

Main Results:

• Analysis of 6,921 paired measurements from 4,248 hospitalizations revealed higher rates of 'hidden hyper/hypothermia' (HHH) in Black and Hispanic/Latino patients compared to White patients.
• Adjusted odds ratios indicated Black patients (1.760) and Hispanic/Latino patients (2.183) were significantly more likely to experience HHH.
• Patients with HHH experienced significantly delayed initiation of key SEP-1 interventions (cultures, antibiotics, lactate measurement) compared to those with accurate readings.

Conclusions:

• Sole reliance on temporal artery thermometers can lead to missed fever or hypothermia, particularly in Asian, Black, and Hispanic patients.
• These inaccuracies are associated with delays in sepsis care bundle initiation, potentially impacting patient outcomes and hospital compliance.
• Routine validation of temporal thermometers with contact thermometers is crucial to mitigate health disparities and ensure timely sepsis management.