{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,14]],"date-time":"2026-09-14T17:52:19Z","timestamp":1789408339905,"version":"build-2803163510"},"reference-count":35,"publisher":"Oxford University Press (OUP)","issue":"7","license":[{"start":{"date-parts":[[2025,7,23]],"date-time":"2025-07-23T00:00:00Z","timestamp":1753228800000},"content-version":"vor","delay-in-days":22,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,7,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>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 (&amp;lt;65) and older patients (\u226565). Evidence quality was assessed using an adapted Quality Assessment of Diagnostic Accuracy Studies-2 tool.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Our search yielded 14\u00a0487 studies; 132 were included after screening. Older adults were less likely to be tachycardic (RR 0.82, 0.69 to 0.97, I2\u00a0=\u200986.5%) with a mean difference in heart rate of 5\u00a0bpm (\u22127 to \u22123\u00a0bpm, I2\u00a0=\u200988.3%). Older adults were less likely to be febrile (RR 0.89, 0.83 to 0.95, I2\u00a0=\u200985.9%) with a mean difference in temperature of 0.14\u00b0C (\u22120.26 to \u22120.02\u00b0C, I2\u00a0=\u200994.6%). Most (129\/132) studies were at high risk of bias.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/ageing\/afaf194","type":"journal-article","created":{"date-parts":[[2025,7,23]],"date-time":"2025-07-23T11:14:51Z","timestamp":1753269291000},"source":"Crossref","is-referenced-by-count":6,"title":["Is age associated with different vital signs in adults presenting to hospital with bacterial infection? A systematic review and meta-analysis"],"prefix":"10.1093","volume":"54","author":[{"given":"Phoebe","family":"Tupper","sequence":"first","affiliation":[{"name":"Critical Care Research Group , Kadoorie Centre for Critical Care Research and Education, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3596-3806","authenticated-orcid":false,"given":"Oliver","family":"Redfern","sequence":"additional","affiliation":[{"name":"Critical Care Research Group , Kadoorie Centre for Critical Care Research and Education, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Charlotte H","family":"Harrison","sequence":"additional","affiliation":[{"name":"Critical Care Research Group , Kadoorie Centre for Critical Care Research and Education, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4654-7311","authenticated-orcid":false,"given":"Stephen","family":"Gerry","sequence":"additional","affiliation":[{"name":"Centre for Statistics in Medicine , Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christopher","family":"Biggs","sequence":"additional","affiliation":[{"name":"Critical Care Research Group , Kadoorie Centre for Critical Care Research and Education, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bethany","family":"Walker","sequence":"additional","affiliation":[{"name":"Critical Care Research Group , Kadoorie Centre for Critical Care Research and Education, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter","family":"Watkinson","sequence":"additional","affiliation":[{"name":"Critical Care Research Group , Kadoorie Centre for Critical Care Research and Education, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK"},{"name":"Oxford Critical Care, Oxford University Hospitals NHS Trust , Oxford ,","place":["UK"]},{"name":"Oxford Biomedical Research Centre, National Institute for Health and Care Research (NIHR), Oxford , Oxfordshire ,","place":["UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2025,7,23]]},"reference":[{"key":"2025072307144638000_ref1"},{"key":"2025072307144638000_ref2","doi-asserted-by":"publisher","first-page":"1642","DOI":"10.1086\/425615","article-title":"The burden of community-acquired pneumonia in seniors: results of a population-based study","volume":"39","author":"Jackson","year":"2004","journal-title":"Clin Infect Dis"},{"key":"2025072307144638000_ref3","doi-asserted-by":"publisher","first-page":"379","DOI":"10.1016\/j.jinf.2018.06.012","article-title":"Diagnostic value of symptoms and signs for identifying urinary tract infection in older adult outpatients: systematic review and meta-analysis","volume":"77","author":"Gbinigie","year":"2018","journal-title":"J Infect"},{"key":"2025072307144638000_ref4","doi-asserted-by":"publisher","first-page":"689","DOI":"10.1007\/s40520-019-01375-4","article-title":"Infections in the older population: what do we know?","volume":"33","author":"Schoevaerdts","year":"2021","journal-title":"Aging Clin Exp Res"},{"key":"2025072307144638000_ref5","doi-asserted-by":"publisher","first-page":"631","DOI":"10.1111\/jgs.14731","article-title":"Geriatric infectious diseases: current concepts on diagnosis and management","volume":"65","author":"Yoshikawa","year":"2017","journal-title":"J Am Geriatr Soc"},{"key":"2025072307144638000_ref6","first-page":"100","article-title":"An early warning scoring system for detecting developing critical illness","volume":"8","author":"Morgan","year":"1997","journal-title":"Clin Intensive Care"},{"key":"2025072307144638000_ref7","doi-asserted-by":"publisher","first-page":"573","DOI":"10.1007\/s11739-022-03189-1","article-title":"The United Kingdom\u2019s National Early Warning Score: should everyone use it? 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