http://orcid.org/0000-0003-0304-9881
Our reply: The author raises three major issues regarding our study. First, the author pointed out that the likelihood ratios (LRs) of the delta heart rate (HR)/body temperature (BT) in our study does not have valuable clinical information. Although the LRs of the delta HR/BT is small and its sole use does not have decisive diagnostic value, we could use this diagnostic tool in combination with other symptoms and physical findings based on multiplication of LRs of those independent symptoms or signs. Additionally, the delta HR/BT could be quickly available finding with no cost to diagnose the bacterial infection in home care setting in which it is not easy to gain access to blood test and imaging test.
Second, Mackenzie and Lyon suggested that HR can be increased in elevation of BT also in noninflammatory processes. We agree with their thoughts and thus we set our cutoff point of the delta HR/BT as greater than 20 for predicting higher probability of bacterial infection.
As author pointed out delta HR/BT could be fluctuated with bacterial infection and other noninfectious causes. Therefore, we suggested in our article that using an appropriate cutoff for delta HR/BT could have potential as a means of quickly providing simple adjunct information regarding bacterial infection in home care settings and our study would be the best available evidence at the current moment.
Third, the author suggested the delta HR/BT might be independent predictor of severity and mortality. Relative tachycardia may be a marker of severe hypoxia or dehydration/hypovolemia in such cases. However, some patients with Legionnaires disease may present with relative bradycardia and thus we may need a validation study for this hypothesis.
Declaration of interest
The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.