Interpretation of Body Temperature and Oxygen Saturation based on Individual Normal Ranges in Habitual Condition: A Step Forward for Applied Precision Medicine
Main Article Content
Abstract
Background: Precision medicine aims to provide patients with care and treatment based on the individual's unique conditions. Current reference ranges for vital parameters are based on healthy reference populations at group level, usually male, individuals excluding long-term medical conditions and daily medication. This entails a risk of misinterpretation on each measurement occasion because a deviant value for the individual may be camouflaged by a normal value at group level. We believe that precision medicine in practice requires that values for vital parameters are interpreted in relation to the individual's normal range in habitual condition.
Aim: To investigate body temperature and oxygen saturation in healthy and frail individuals, based on individual normal range in habitual condition.
Methods: The sample consisted of 70 healthy individuals, 27 to 80y, 20 nursing home residents, 70 to 100y, and 32 patients in hospital-affiliated home care, 60 to 95y. Age, gender, physical ability, chronic disease, medication was documented. Ear temperature and oxygen saturation were performed for five mornings before getting out of bed and taking medicine, food or drink.
Results: The range for body temperature in healthy subjects was 34.3°C to 37.7 °C and in frail elderly 34.5°C to 37.7 °C. No differences in the variation of normal range in body temperature was found between healthy and frail individuals, 0.7°C + 0.4°C, though the variation between min and max temperature were large; 2.4°C vs 2.7°C and 2.9°C vs 2.3°C in healthy and frail subjects, respectively. A max temperature of < 36.2°C was more frequent in healthy subjects. The range for oxygen saturation varied between 85% to 99%, in healthy subjects and 75% to 100% in frail elderly. No healthy subjects had a max oxygen saturation value <94%. Inflammatory processes influenced body temperature and oxygen saturation in frail elderly.
Conclusion: To promote precision medicine and health our results show that it is necessary to interpret body temperature and oxygen saturation based on individual normal ranges in habitual condition. By interpreting deviations from the individual's normal interval, the possibility of necessary care efforts increases without delay, which can be decisive before further deterioration.
Keywords:
Normal variation, reference values, body temperature, oxygen saturation, frail elderly
Article Details
How to Cite
M, Sund Levander; I, Hagman; E, Grodzinsky.
Interpretation of Body Temperature and Oxygen Saturation based on Individual Normal Ranges in Habitual Condition: A Step Forward for Applied Precision Medicine.
Medical Research Archives, [S.l.], v. 11, n. 4, apr. 2023.
ISSN 2375-1924.
Available at: <https://esmed.org/MRA/mra/article/view/3726>. Date accessed: 29 may 2023.
doi: https://doi.org/10.18103/mra.v11i4.3726.
Section
Research Articles
The Medical Research Archives grants authors the right to publish and reproduce the unrevised contribution in whole or in part at any time and in any form for any scholarly non-commercial purpose with the condition that all publications of the contribution include a full citation to the journal as published by the Medical Research Archives.
References
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35. Schoevaerdts D, Sibille FX, Gavazzi G. Infections in the older population: what do we know? Aging Clin Exp Res. 2021;33(3):689-701.
36. Smith P, Sherlaw-Johnson C, Ariti C, Bardsley M. Hospital admissions from care homes. 2015.
37. Boockvar K, Gruber-Baldini A, Burton L, Zimmerman S, Magaziner j. Outcomes of infection in nursing home residents with and without early hospital transfer. Journal of American Geriatric Socieity. 2005;53:590-596.
38. Eriksson I, Gustafson Y, Fagerstom L, Olofsson B. Prevalence and factors associated with urinary tract infections (UTIs) in very old women. Int Psychogeriatric. 2010;50:132-135.
39. Givens JL, Selby K, Goldfeld KS, Mitchell SL. Hospital transfers of nursing home residents with advanced dementia. J Am Geriatr Soc. 2012;60(5):905-909.
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3. Lindstedt G, Tryding N. There is a difference between decision limits and reference intervals Reference intervals are based on healthy individuals, decision limits from patients (Det är skillnad på beslutsgränser och referensintervall Referensintervall utgår från friska individer, beslutsgränser från patienter) In Swedish. Läkartidningen:. 2007;28-29:2076-2079.
4. Smer. Precision medicine (In Swedish). In: Affairs. MoHaS, ed. https://smer.se/teman/precisionsmedicin/: : The Swedish National Council on Medical Ethics (Smer); 2022.
5. Academies N. The National Academies Collection: Reports funded by National Institutes of Health. In: Toward Precision Medicine: Building a Knowledge Network for Biomedical Research and a New Taxonomy of Disease. Washington (DC): National Academies Press (US) Copyright © 2011, National Academy of Sciences.; 2011.
6. Nilsson Vindefjärd A. Precision health - The way forward: A knowledge base from the "Agenda for health and prosperity". In Swedish (Precisionshälsa- Vägen framåt: Ett kunskapsunderlag från ”Agenda för hälsa och välstånd"). Stockholm: Forska!Sverige. ;2022.
7. Ginsberg MD, Sternau LL, Globus MY, et al. Therapeutic modulation of brain temperature relevance to ischemic brain injury. Cerebrovascular and Brain Metabolism Review. 1992;4:189-225.
8. Parimbelli E, Marini S, Sacchi L, Bellazzi R. Patient similarity for precision medicine: A systematic review. J Biomed Inform. 2018;83:87-96.
9. Wunderlich CA, Reeve JC. The course of the temperature in diseases: a guide to clinical thermometry. American Journal of Medical Science. 1869;57:423-447.
10. Wunderlich CA, Seguin E. Medical Thermometry and Human Temperature. New York: William Wood & Co; 1871.
11. Sund Levander M, Grodzinsky E. The challenge of infections in frail elderly: The story of Mr Nilsson. Clinical Medical Reviews and Case Reports (CMRCS). 2016; Online publication 2015-08-26.
12. Sund Levander M, Grodzinsky E. Variation in normal ear temperature. American Journal of the Medical Sciences. 2017;54(4):370-378.
13. Sund-Levander M, Grodzinsky E. Accuracy when assessing and evaluating body temperature in clinical practice: Time for a change? Thermology International. 2012;22(Appendix 1 to Number 2 July):25-32.
14. Sund-Levander M, Grodzinsky E, Loyd D, Wahren LK. Error in body temperature assessment related to individual variation, measuring technique and equipment. International Journal of Nursing Practice. 2004;10:216-223.
15. Sund-Levander M, Wahren LK. The impact of ADL-status, dementia and body mass index on normal body temperature in elderly nursing home residents. Archives of Gerontology and Geriatrics. 2002;35:161-169.
16. Geneva I, Cuzzo B, Fazili T, Javaid W. Normal body temperature: a systematic review. . Open Forum Infect Dis 2019;6(ofz032.).
17. Diamond A, Lye C, Prasad D, Abbott D. One size does not fit all: assuming the same normal body temperature for everyone is not justified. . PLoS One16:. 2021;16(e0245257).
18. Protsiv M, Ley C, Lankester J, Hastie T, Parsonnet J. Decreasing human body temperature in the United States since the Industrial Revolution. eLIFE. 2020;9(e49555).
19. Sund-Levander M, Forsberg C, Wahren LK. Normal oral, rectal, tympanic and axillary body temperature in adult men and women: A systematic literature review. Scandinavian Journal of Caring Sciences. 2002;16(2):122-128.
20. Grodzinsky E, Sund Levander M, eds. Understanding fever and body temperature. A cross-diciplinary approach to clinucal practice. Switzerland: Palgrave Macmillan; 2020.
21. Tingström P, Milberg A, Rodhe N, Grodzinsky E, Sund-Levander M. Nursing assistants: “He seems to be ill”– a reason for nurses to take action: Validation of the Early Detection Scale of Infection (EDIS). BMC Geriatrics. 2015(122):2-10.
22. Tingström P, Milberg A, Sund-Levander M. Early Nonspecific Signs and Symptoms of Infection in Institutionalized Elderly Persons: Perceptions of Nursing Assistants. Scandinavian Journal of Nursing Sciences 2010;24:24-31.
23. Bertils K. Fever in Interaction : Body, Knowledge, and Legitimacy in Swedish Primary Care Consultations In Swedish (Feber i interaktion. Kropp, kunskap och legitimitet i svenska primärvårdssamtal). Upsala: Faculty of Linguistics, Department of Linguistics and Philology, Upsala University; 2022.
24. Mackowiak PA. Fever's upper limit. In: Mackowiak PA, ed. Fever. Basic Mechanisms and Management. 2 ed. Philadelphia, New York: Lippincott Raven; 1997:147-163.
25. Sund Levander M, Tingström P. Fever or not fever – that’s the question: A cohort study of simultaneously measured rectal and ear temperatures in febrile patients with suspected infection. Clinical Nursing Studies. 2018;6(2):47-54.
26. Sund-Levander M, Grodzinsky E. Time for a change to assess and evaluate body temperature in clinical practice. International Journal of Nursing Practice. 2009;15:241-249.
27. Toros A, Grodzinsky E, Karlsson N, Nilsson M, Sund-Levander M. Use of temperature changes and proinflammatory biomarkers to diagnose bacterial infections in patients with severe cerebral trauma Journal of Neuro Critical Care. 2022(https://doi.org/10.18700/jnc.210031).
28. McConeghy KW, White E, Panagiotou OA, et al. Temperature Screening for SARS-CoV-2 in Nursing Homes: Evidence from Two National Cohorts. J Am Geriatr Soc. 2020;68(12):2716-2720.
29. Morita S, Matsuyama T, Ehara N, et al. Prevalence and outcomes of accidental hypothermia among elderly patients in Japan: Data from the J-Point registry. Geriatr Gerontol Int. 2018;18(10):1427-1432.
30. Ae R, Kojo T, Okayama M, et al. Caregiver daily impression could reflect illness latency and severity in frail elderly residents in long-term care facilities: A pilot study. Geriatr Gerontol Int. 2016;16(5):612-617.
31. Allemann H, Sund Levander M. Nurses’ actions in response to nursing assistants’ observations of signs and symptoms of infections among nursing home residents. Nursing Open. 2015;2(3):97-104.
32. Eikelenboom-Boskamp A, Saris K, van Loosbroek M, et al. Prevalence of healthcare-associated infections in Dutch nursing homes: follow-up 2010-2017. J Hosp Infect. 2019;101(1):49-52.
33. Limpawattana P, Phungoen P, Mitsungnern T, Laosuangkoon W, Tansangworn N. Atypical presentations of older adults at the emergency department and associated factors. Arch Gerontol Geriatr. 2016;62:97-102.
34. Moyo P, Zullo AR, McConeghy KW, et al. Risk factors for pneumonia and influenza hospitalizations in long-term care facility residents: a retrospective cohort study. BMC Geriatr. 2020;20(1):47.
35. Schoevaerdts D, Sibille FX, Gavazzi G. Infections in the older population: what do we know? Aging Clin Exp Res. 2021;33(3):689-701.
36. Smith P, Sherlaw-Johnson C, Ariti C, Bardsley M. Hospital admissions from care homes. 2015.
37. Boockvar K, Gruber-Baldini A, Burton L, Zimmerman S, Magaziner j. Outcomes of infection in nursing home residents with and without early hospital transfer. Journal of American Geriatric Socieity. 2005;53:590-596.
38. Eriksson I, Gustafson Y, Fagerstom L, Olofsson B. Prevalence and factors associated with urinary tract infections (UTIs) in very old women. Int Psychogeriatric. 2010;50:132-135.
39. Givens JL, Selby K, Goldfeld KS, Mitchell SL. Hospital transfers of nursing home residents with advanced dementia. J Am Geriatr Soc. 2012;60(5):905-909.
40. Moore A, McKelvie S, Glogowska M, Lasserson D, Hayward G. Infection in older adults: a qualitative study of patient experience. Br J Gen Pract. 2020;70(694):e312-e321.
41. Mayne S, Bowden A, Sundvall PD, Gunnarsson R. The scientific evidence for a potential link between confusion and urinary tract infection in the elderly is still confusing - a systematic literature review. BMC Geriatr. 2019;19(1):32.
42. Sundvall P. Urine culture doubtful in determining etiology of diffuse symptoms among elderly individuals- a cross-sectional study of 32 nursing homes. . . BMC Family Practice 12 (36). 2011;12(36).
43. Meng Y, Wang J, Wen K, et al. Clinical Features and Laboratory Examination to Identify Severe Patients with COVID-19: A Systematic Review and Meta-Analysis. BioMed Research International. 2021;1.
44. Lippi G, Nocini R, Mattiuzzi C, Henry B. Is body temperature mass screening a reliable and safe option for preventing COVID-19 spread? Diagnosis. 2021;9:195-198.
45. James K, Erlinge D, Herlitz J, et al. Effect of Oxygen Therapy on Cardiovascular Outcomes in Relation to Baseline Oxygen Saturation. JACC Cardiovasc Interv. 2020;13(4):502-513.
46. Klompas M, Ochoa A, Ji W, et al. Prevalence of Clinical Signs Within Reference Ranges Among Hospitalized Patients Prescribed Antibiotics for Pneumonia. JAMA Netw Open. 2020;3(7):e2010700.
47. WHO. Hypoxia, descisionmaking support. In. https://cdn.who.int/media/docs/default-source/integrated-health-services-(ihs)/psf/pulse-oximetry/who-ps-pulse-oxymetry-hypoxia-mgt-plan-en.pdf?sfvrsn=2b872fe5_4: Worlsd Health Organization; 2011.
48. Vold ML, Aasebø U, Hjalmarsen A, Melbye H. Predictors of oxygen saturation ≤95% in a cross-sectional population based survey. Respir Med. 2012;106(11):1551-1558.
49. Dennis A, Hardy L. Defining a reference range for vital signs in healthy term pregnant women undergoing caesarean section. Anaesth Intensive Care. 2016;44(6):752-757.
50. Crocker ME, Hossen S, Goodman D, et al. Effects of high altitude on respiratory rate and oxygen saturation reference values in healthy infants and children younger than 2 years in four countries: a cross-sectional study. Lancet Glob Health. 2020;8(3):e362-e373.
51. Soria R, Egger M, Scherrer U, Bender N, Rimoldi SF. Pulmonary artery pressure and arterial oxygen saturation in people living at high or low altitude: systematic review and meta-analysis. J Appl Physiol (1985). 2016;121(5):1151-1159.
52. Schult S, Canelo-Aybar C. Oxygen saturation in healthy children aged 5 to 16 years residing in Huayllay, Peru at 4340 m. High Alt Med Biol. 2011;12(1):89-92.
53. Lehnertz NB, Lifson A, Galloway E, et al. Temperature and oxygen saturation in skilled nursing facility residents positive for SARS-CoV-2 prior to symptom onset. J Am Geriatr Soc. 2022;70(2):363-369.
54. FDA. Pulse Oximeter Accuracy and Limitations: FDA Safety Communication. In. https://www.fda.gov/medical-devices/safety-communications/pulse-oximeter-accuracy-and-limitations-fda-safety-communication: The U.S. Food and Drug Administration (FDA); 2021.
55. ISO. Medical electrical equipment_ Part 2-56: Particular requirements för basic safety and essential performance of clinical thermometers for body temperature measurement. In. Vol ISO 80601-2-56: 2009:E. Switzerland2014.
56. Hulter Åsberg K. Assessment of ADL in home-care for the elderly. Scandinavian Journal of Social Medicine. 1986;14:105-111.
57. Hulter Åsberg K. The common language of Katz's index of ADL in six studies of aged and disabled patients. Scandinavian Journal of Caring Sciences. 1989;2(4):171-178.
58. Katz S, Ford AB, Moskiwitz W, Jaffe MW. Studies of illness in the aged. The index of ADL: A standardized measure of biological and psychosocial function. Journal of the American Medical Association. 1963;185:914-919.
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