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

ImportanceEarly identification of fever or hypothermia is crucial for diagnosing sepsis. Despite their increased use across healthcare systems, concerns have been raised about the accuracy of temporal thermometers among Black patients. ObjectiveTo study the performance of temporal thermometry across race and ethnicity, and its impact on the initiation of the sepsis management bundle (SEP-1). DesignIn this retrospective cohort study, records from 2008-2024 in 123 U.S. hospitals were analyzed, including electronic health records from Duke, MIMIC-IV, eICU-CRD-1, and eICU-CRD-2. Patients were included if they had a temporal measurement within one hour of an oral/core measurement (esophageal, bladder, rectal). Main Outcomes and MeasuresHidden Fever was defined when the temporal thermometer read [&le;] 38{degrees}C but oral/core measurement > 38{degrees}C and Hidden Hypothermia as temporal temperature [&ge;] 36{degrees}C but oral/core < 36{degrees}C. The primary outcome was Hidden Hyper/Hypothermia (HHH) when either Hidden Fever or Hidden Hypothermia happened. Observed Hyper/Hypothermia (OHH) corresponded to an agreement between both measurements, used as a control. To study the impact of temporal thermometry underperformance on SEP-1 bundle initiation, we assessed time to culture ordering, antibiotics administration, and lactate measurement. A composite of these three, whichever happened first, was defined as our secondary outcome. Results6,921 paired temperature measurements were studied for the primary outcome analysis, corresponding to 4,248 hospitalizations (2.6% Asian; 12.4% Black; 2.6% Hispanic/Latino; 83.4% White; 44.9% female; 7.7% with HHH) from 115 hospitals. After adjusting for confounders, Black [OR (95% CI): 1.760 (1.219, 2.541), p=0.003] and Hispanic/Latino [OR (95% CI): 2.183 (1.226, 3.888), p=0.008] patients were significantly more likely to present with HHH than White patients. For the study of the secondary outcome, 434 patients had either OHH or HHH. Compared to patients with OHH, patients with HHH had significantly delayed secondary outcomes, with log-rank p-value of 0.002. Conclusions and RelevanceSolely relying on temporal thermometry can lead to missed hyper/hypothermia events, especially among Asian, Black, and Hispanic patients. This has been associated with delays in the initiation of the SEP-1 bundle, which may hamper health systems compliance with reimbursement programs. Key PointsO_ST_ABSQuestionC_ST_ABSAre there racial differences in temporal thermometry that result in missed hyper/hypothermia, and are these associated with delays in sepsis bundle care (SEP-1) initiation? FindingsIn this multicenter retrospective cohort study of 4,248 hospitalizations, Asian, Black, and Hispanic patients were more likely to have hidden hyper/hypothermia when using temporal thermometers, as compared to oral/core measurements. These missed events were associated with delayed SEP-1 interventions (three out of four were studied: culture orders, antibiotic administration, and lactate measurements). MeaningReliance on temporal thermometry could exacerbate health disparities and hamper hospital systems compliance with reimbursement programs. Temporal thermometers should therefore be routinely validated with contact thermometers.