Q&A: Sepsis temperature threshold

Q: We have seen conflicting information on the upper limit temperature threshold for sepsis with some information suggesting greater than 38°C (>38°C) and some stating 38.3°C (>38.3°C). The >38°C threshold is used in the Sepsis-1 bundle by CMS; however, we have been instructed by our consulting group to use >38.3°C. This has resulted in confusion for our providers. How did ACDIS make the decision to use >38°C?

A: In the ACDIS Pocket Guide, we chose >38°C based on the Sepsis-1 bundle, what was indicated in the Sepsis-2 definition, as well as what was given by the systemic inflammatory response syndrome (SIRS) criteria. Please remember that each physician and each organization can identify their own criteria. As to why your consulting group has identified >38.3°C as the proper threshold, I would suggest that you ask for their rationale. As an organization, ACDIS suggests that you work with your medical staff to identify defined parameters (i.e., diagnostic criteria) for the presence of sepsis.

Also, note that temperature spikes in sepsis will vary, so this is but one piece of the diagnostic criteria. Individuals who are immunocompromised, such as the very young and the very old, may not demonstrate a fever even in the presence of sepsis. This indicator must be considered within the context of the patient’s history, their medications, the infection, and their comorbidities. Sepsis may also be present in a patient who is afebrile; in cases like these, CDI specialists should encourage providers to indicate why a patient is presenting atypically.

Editor’s note: Laurie Prescott, RN, MSN, CCDS, CCDS-O, CDIP, CRC, ACDIS interim director and CDI education director, answered this question. Contact her at lprescott@acdis.org. Get your copy of the 2023 ACDIS Pocket Guide here.