Accuracy of perception and touch for detecting fever in adults: a hospital‐based study from a rural, tertiary hospital in Central India

OBJECTIVES: To evaluate the diagnostic accuracy of the patient's perception, and of the touch of patient attendants and a doctor for detecting fever. METHODS: We enrolled patients older than 13 years who presented with history of fever to the in- and out-patient departments of a rural teaching hospital. The design was a double-blind, cross-sectional analysis of a hospital-based case series, independently comparing reported history of fever and touch of patient attendant and that of doctor against an established reference standard (axillary temperature > 37.5 degrees C). Diagnostic accuracy was measured by computing sensitivity, specificity, and likelihood ratio values. The agreement between the patient, his attendant and the doctor was assessed by kappa statistic. RESULTS: We studied 462 patients of whom 274 (59.3%) were men. A total of 206 patients (44.58%) had fever. The patient's perception of fever (LR+ 1.77; 95% CI 1.52, 2.06), patient attendant's touch (LR+ 2.03; 95% CI 1.74, 2.36) and the doctor's touch (LR+ 3.08; 95% CI 2.51, 3.71) did not accurately distinguish those with and without fever. Doctors (LR- 0.20; 95% CI 0.17, 0.34) and patient attendants (LR- 0.24; 95% CI 0.14, 0.28) were more accurate in ruling out fever. The patient's perception agreed moderately with patient attendant's touch (kappa = 0.44; 95% CI 0.36, 0.53), and the doctor's assessment (kappa = 0.47; 95% CI 0.39, 0.55). There was moderate agreement between patients' attendants and the study doctor (kappa = 0.48; 95% CI 0.40, 0.56). CONCLUSIONS: Our findings suggest that patients, their attendants or doctors cannot accurately detect the presence of a fever without using a thermometer. Doctors should confirm a history of fever by recording temperature.