Temperature in Nursing Home Residents Systematically Tested for SARS-CoV-2
Temperature in Nursing Home Residents Systematically Tested for SARS-CoV-2
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DOI：
10.1016/j.jamda.2020.06.009
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发表时间：
2020-07-01
影响因子：
7.6
通讯作者：
Gravenstein, Stefan
中科院分区：
文献类型：
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作者：
Rudolph, James L.;Halladay, Christopher W.;Gravenstein, Stefan
目的：许多感染SARS-CoV-2的养老院居民未能通过相关的新冠肺炎综合征的标准筛查来确定。目前的养老院新冠肺炎筛查指南包括发烧评估，定义为至少38摄氏度。本研究的目的是描述疗养院居民普遍检测SARS-CoV-2前后的温度变化。设计：队列研究。设置和对象：退伍军人管理局(VA)运营134个社区生活中心，类似养老院，为不能独立生活的居民提供住房。对慢性淋巴细胞性肺炎的VA指南指导了新冠肺炎的日常临床筛查，其中包括体温评估。测量：所有的慢性阻塞性肺病患者(n=7325)都接受了SARS-CoV-2检测。我们报告了SARS-CoV-2通用检测前后14天窗口内居民的体温。结果：443名(6.0%)居民检出SARS-CoV-2。SARS-CoV-2阳性居民的平均最高气温为37.66(0.69)，而SARS-CoV-2阴性居民的平均最高气温为37.11(0.36)(P=.001)。SARS-CoV-2感染者的体温在检测前7天开始上升，并在14天的随访中保持较高水平。在SARS-CoV-2呈阳性的居民中，在调查期间只有26.6%(n=118)的人达到了38.0摄氏度的发烧阈值。大多数确诊为SARS-CoV-2的居民(62.5%，n=277)确实经历了比基准值高出2摄氏度或更多0.5摄氏度的情况。一组SARS-CoV-2患者(20.3%，n=90)的体温从未偏离基线-0.5摄氏度。结论和启示：单一的温度筛查不太可能发现疗养院居民感染SARS-CoV-2。根据患者的基线重复测量体温可以提高灵敏度。应重新考虑目前作为SARS-CoV-2感染筛查标准的发烧阈值。由爱思唯尔公司代表AMDA(急性后和长期护理医学学会)出版。
Objectives: Many nursing home residents infected with SARS-CoV-2 fail to be identified with standard screening for the associated COVID-19 syndrome. Current nursing home COVID-19 screening guidance includes assessment for fever, defined as a temperature of at least 38.0 degrees C. The objective of this study was to describe the temperature changes before and after universal testing for SARS-CoV-2 in nursing home residents.Design: Cohort study.Setting and Participants: The Veterans Administration (VA) operates 134 Community Living Centers (CLC), similar to nursing homes, that house residents who cannot live independently. VA guidance to CLCs directed daily clinical screening for COVID-19 that included temperature assessment.Measures: All CLC residents (n = 7325) underwent SARS-CoV-2 testing. We report the temperature in the window of 14 days before and after universal SARS-CoV-2 testing among CLC residents. Baseline temperature was calculated for 5 days before the study window.Results: SARS-CoV-2 was identified in 443 (6.0%) residents. The average maximum temperature in SARS-CoV-2epositive residents was 37.66 (0.69) compared with 37.11 (0.36) (P = .001) in SARS-CoV-2 enegative residents. Temperatures in those with SARS-CoV-2 began rising 7 days before testing and remained elevated during the 14-day follow-up. Among SARS-CoV-2epositive residents, only 26.6% (n = 118) met the fever threshold of 38.0 degrees C during the survey period. Most residents (62.5%, n = 277) with confirmed SARS-CoV-2 did experience 2 or more 0.5 degrees C elevations above their baseline values. One cohort of SARS-CoV-2 residents' (20.3%, n = 90) temperatures never deviated >0.5 degrees C from baseline.Conclusions and Implications: A single screening for temperature is unlikely to detect nursing home residents with SARS-CoV-2. Repeated temperature measurement with a patient-derived baseline can increase sensitivity. The current fever threshold as a screening criteria for SARS-CoV-2 infection should be reconsidered. Published by Elsevier Inc. on behalf of AMDA - The Society for Post-Acute and Long-Term Care Medicine.