Blood cultures for febrile patients in the acute care setting: too quick on the draw?

PURPOSE: To review the fever literature and determine how 38.3 degrees C was deemed the optimal fever threshold that predicts bacteremia.

DATA SOURCES: PubMed, MEDLINE, Cochrane database, and the Cumulative Index to Nursing and Allied Health.

CONCLUSIONS: A temperature of 38.3 degrees C has come to be the threshold value that typically triggers diagnostic fever evaluation for bacteremia in hospitalized patients. Studies that define predictors of bacteremia provide conflicting results, and most bacteremia predictor models have not been externally validated. Therefore, current fever guidelines are based on consensus opinion rather than large clinical trials identifying a specific threshold with high sensitivity and a high negative predictive value.

IMPLICATIONS FOR PRACTICE: The use of a single temperature threshold of 38.3 degrees C for the prediction of bacteremia is not sufficient in all patients. Additional factors should be considered, including patient population, supporting clinical signs and symptoms, and the patient's medical history.