Is age associated with different vital signs in adults presenting to hospital with bacterial infection? A systematic review and meta-analysis

TL;DR

Older adults with bacterial infections show less tachycardia and fever compared to younger adults, suggesting vital signs may not reliably indicate infection in the elderly.

Contribution

This study provides a systematic review and meta-analysis showing that older adults present with less pronounced vital sign abnormalities during bacterial infections.

Findings

Older adults are less likely to be tachycardic compared to younger adults with bacterial infections.

Older adults are less likely to be febrile compared to younger adults with bacterial infections.

Abstract

It has long been suspected that the vital sign abnormalities that accompany bacterial infection are subtle or absent in older adults. This review summarises the evidence for whether older adults present with different vital sign abnormalities to younger adults when hospitalised with bacterial infection.

MEDLINE, EMBASE and CINAHL EBSCO were searched from inception to 19 December 2024 for English-language research articles of patients hospitalised with bacterial infection reporting age and admission vital signs. We used meta-regression to assess how vital signs vary with age. Where studies reported vital signs in multiple age groups, we undertook a meta-analysis in younger (<65) and older patients (≥65). Evidence quality was assessed using an adapted Quality Assessment of Diagnostic Accuracy Studies-2 tool.

Our search yielded 14 487 studies; 132 were included after screening. Older adults were less likely to be tachycardic (RR 0.82, 0.69 to 0.97, I2 = 86.5%) with a mean difference in heart rate of 5 bpm (−7 to −3 bpm, I2 = 88.3%). Older adults were less likely to be febrile (RR 0.89, 0.83 to 0.95, I2 = 85.9%) with a mean difference in temperature of 0.14°C (−0.26 to −0.02°C, I2 = 94.6%). Most (129/132) studies were at high risk of bias.

Whilst differences in absolute values were small, there was consistency in the finding that older adults were less likely than younger adults to be tachycardic or febrile. As vital signs at presentation may prompt suspicion of infection, influencing investigations and treatment, special consideration for the possibility of infection in older patients with normal vital signs may be warranted.

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