Differences Shown In Fever Detection Between Black And White Patients

Sivasubramanium V. Bhavani, MD, MS

Black and White patients have shown differences in fever detection when comparing temporal and oral thermometry, a recent research letter suggested.

Clinicians use both oral and temporal artery thermometers, also known forehead thermometers, in hospital settings to detect fevers in patients. As health care systems use temperature cutoffs to indicate the need for further care, discrepancies between racial groups would result in fewer treatments for groups without the proper indicators.

“Recent studies have found that pulse oximetry can lead to missed hypoxemia in Black patients,” explained investigators, led by Sivasubramanium V. Bhavani, MD, MS, from the Emory University School of Medicine Division of Pulmonary, Allergy, Critical Care, and Sleep Medicine. “Similar racial differences in thermometry could lead to missed fever, delayed diagnoses, and increased mortality in Black patients.”

It is for reasons relating to disparities in fever detection and increased long term mortality concerns for Black patients that this study by Bhavani and colleagues was conducted.

Research and Methods

Bhavani and colleagues’ research was done through a retrospective cross-sectional analysis using data collected between 2014 - 2021 from patients admitted to 1 of 4 Emory hospitals. Criteria for inclusion was the suspicion of infection due to a combination of body fluid cultures and antibiotic use within a day of presentation.

The investigators were able to record the data due to the patients’ racial backgrounds being self-reported when they registered at their respective hospitals. The researchers also disregarded Hispanic, Asian, or other backgrounds due to small sample size.

The investigators recorded the first set of each patient’s temporal and oral temperatures that were measured within an hour of each other on each patient’s first day. They recorded temporal temperatures using an Exergen TAT-5000 thermometer, and oral temperatures were found through a Welch Allyn SureTemp Plus thermometer. The researchers used a total of 2031 Black patients and 2344 White patients’ measurements.

They compared the paired measurement data of both Black and White hospital patients by using paired t-tests for each demographic group, controlling for hospital, comorbidities, and demographics. Their data collection involved the analyzing of both groups by recording temperature route measurement and fever.

The analysis was performed several times by the investigators under several different fever cutoffs: 37.8 °C, 38.3 °C, and 38.5 °C, with a sensitivity analysis on temperature measurements from the first hour of each patient’s presentation. The researchers set the statistical significance at P < .05 using 2-tailed tests.

Study Results

The investigators found that while White patients showed no differences in temporal (36.97 °C) or oral temperature (36.95 °C)  readings (difference, 0.02; 95% CI, −0.01  to 0.05; P = .18), Black patients did had lower temporal temperatures (36.98 °C) compared to oral temperature (37.05 °C) readings (difference, −0.07; 95% CI, −0.10 to −0.04; P < .001). They added that there were no differences whether oral or temporal temperature was recorded first.

The researchers found that in Black patients, fever prevalence was 10.1% for temporal and 13.2% for oral measurement, whereas White patients maintained a fever prevalence of 10.8% for temporal and 10.2% for oral measurement. Furthermore, temporal measurement was associated with a significantly lower odds ratio (OR) of fever for Black patients (OR, 0.74; 95% CI, 0.61-0.90; P = .002) as opposed to White patients (OR, 1.07; 95% CI, 0.89-1.29; P = .47).

This lower odds of fever detection for Black patients may result in worse medical outcomes for this demographic group, and the investigators added some potential reasons for why this difference in measurement may have occurred.

“Research suggests skin emissivity may play a role in measurement variability, but the relationship between skin emissivity and pigmentation is uncertain,” they wrote. “The racial difference found may stem from the medical device or from systemic mishandling of the device (eg, not scanning the forehead sufficiently). Differences in detection of fever could lead to delays in antibiotics and medical care for Black patients.”

The research letter, “Racial Differences in Detection of Fever Using Temporal vs Oral Temperature Measurements in Hospitalized Patients,” was published online in JAMA Network Open.