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Likelihood Ratio (LR) in Emergency Medicine


NO fever, NO bacteriaemia?

Clinical Scenario

A 80 yo nursing home resident woman  is brought to the ED by ambulance. 
“Hypothension, cough and a hystory of heart failure ”, refers the nurse. 
She looks pale and confused, her respiratory rate is 22, oxygen saturation on room air is 90%. Ear temperature is 36,5°C, BP  is 90/60 mmHg, HR is 95.
There’re pulmonary rales. Lactate are 4 mmol/dl.

Is it a low flow heart failure or is there and underline pneumonia? Does the absence of fever rule out bacteriaemia? 


Although fever has been incorporated into prediction rules for blood infections, proven infection may be present in the absence of fever. 
Temperature as a single parameter is a poor indicator of bacteremia. 


TA Seigel 
J Emerg Med 2012 vol 42 n3 pp 254-259. 

Ciro Paolillo


  1. Fever could be a sign of a big underlying problem. Just a thought .Newton@KU School of medicine

  2. http://www.emergency-medicine1.tk/