Exploring temperature trajectories in emergency department sepsis patients

Area of Science:

• Emergency Medicine
• Critical Care Medicine
• Clinical Informatics

Background:

• Sepsis poses a significant global health challenge, particularly in emergency departments (EDs).
• While the quick Sequential Organ Failure Assessment (qSOFA) score expanded sepsis diagnostics, traditional reliance on body temperature requires re-evaluation.
• Understanding diverse body temperature patterns in sepsis is vital for accurate diagnosis and treatment.

Purpose of the Study:

• To analyze distinct body temperature patterns in emergency department sepsis patients.
• To investigate the impact of these temperature patterns on patient treatment and outcomes.
• To assess the utility of body temperature trajectories in sepsis management.

Main Methods:

• Retrospective cohort study utilizing the MIMIC-IV database.
• Group-based trajectory modeling to identify body temperature patterns in sepsis patients diagnosed within 12 hours of ED triage.
• Statistical analysis including ANOVA and chi-squared tests to compare patient characteristics and outcomes across identified temperature subgroups.

Main Results:

• Four distinct body temperature patterns were identified: Hypothermic (0.9%), Normothermic (74.1%), Progressive Fever (10.7%), and Fever Resolver (14.4%).
• The Hypothermic group exhibited the highest mortality rate (37.5%).
• Mortality rates for Normothermic, Progressive Fever, and Fever Resolver groups were 11.7%, 9.14%, and 9.78%, respectively (p < 0.001).

Conclusions:

• Fever is not a universally present or reliable indicator for sepsis diagnosis.
• A significant proportion of sepsis patients present with normothermia or hypothermia, with hypothermia associated with increased mortality.
• Incorporating a broader spectrum of body temperature patterns into sepsis assessment protocols may improve patient outcomes.