NexTemp thermometer can be used interchangeably with tympanic or mercury thermometers for emergency department use

Objectives To determine the agreement between the chemical dot NexTemp thermometer with mercury and tympanic thermometers and the repeatability of measurements using these devices. Methods A prospective study involving a convenience sample of 194 consenting adult patients presenting to the ED, Freemasons Hospital, East Melbourne, Victoria, Australia. A survey of emergency medical staff was conducted to determine what they considered an acceptable level of agreement and repeatability for a putative new thermometer. The NexTemp thermometer’s performance was judged against this. For each thermometer, a set of two temperature measurements was made in every patient. The sequence of the set of readings (and hence device) was random between patients and the staff member performing one set was blinded to the results of the other two sets of readings in each patient. The method of Bland and Altman was used for assessing agreement and repeatability. Results Clinicians considered that a new thermometer should exhibit repeatability of ±0.3°C and agree with existing devices within ±0.5°C. The tympanic thermometer had 95% limits of repeatability of ?0.8–0.5°C compared with the NexTemp (?0.3–0.4°C) and mercury thermometers (?0.3–0.4°C). The NexTemp thermometer agreed with mercury thermometer within ?0.6–0.5°C. The tympanic thermometer agreed with the mercury thermometer within ?1.0–1.1°C. Conclusion Based on temperature measurement only, the NexTemp thermometer can be used interchangeably with current mercury and tympanic thermometers.     

Comparison of three different thermometers in evaluating the body temperature of healthy young adult individuals

The aim of this study was to compare the measurement values obtained with a non‐contact infrared thermometer, a tympanic thermometer and a chemical dot thermometer. The research population was composed of students studying in two departments of a university in Ankara. A total of 452 students who fit the inclusion criteria of the study and volunteered to participate were included in the sample. Body temperature measurements with different thermometers were performed by the same researcher at the same room temperature. Data were analyzed in a computerized environment by SPSS 15.0 statistical program pack and Bland–Altman graph. Mean age of healthy young adults participating in the study was 19.66 ± 0.94, and 55.1% of them were female. The agreement limits for non‐contact infrared and chemical dot was between ?1.30 and 0.32°C; for non‐contact infrared and tympanic was between ?1.26 and 0.13°C; and for chemical dot and tympanic ?0.89 and 0.74°C. It was determined that, although the measurement values of the tympanic membrane and chemical dot thermometers conformed with each other, the conformity of the non‐contact infrared thermometer was weak.     

Temperature measurement: comparison of non-invasive methods used in adult critical care

Aims and objectives. To assess accuracy and reliability of two non‐invasive methods, the chemical (Tempa.DOT^TM) and tympanic thermometer (Genius^TM First Temp M3000A), against the gold standard pulmonary artery catheter, and to determine the clinical significance of any temperature discrepancy using an expert panel. Background. There is continued debate surrounding the use of tympanic thermometry in clinical practice. Design. Prospective study. Methods. A total of 160 temperature sets were obtained from 25 adult intensive care patients over a 6‐month period. Results. About 75.2% (n = 115) of chemical and 50.9% (n = 78) of tympanic readings were within a ±0.0–0.4 °C range of the pulmonary artery catheter. Both the chemical and tympanic thermometers were significantly correlated with temperatures derived from the pulmonary artery catheter (r = 0.81, P < 0.0001 and r = 0.59, P < 0.0001) and limits of agreement were ?0.5–0.9 °C and ?1.2–1.2 °C respectively. The chemical thermometer was associated with a mean temperature difference of 0.2 °C, which increased 0.4 °C when used in conjunction with a warming blanket. With regard to clinical significance 15.3% (n = 26) of chemical and 21.1% (n = 35) of tympanic readings might have resulted in patients receiving delayed interventions. Conversely 28.8% (n = 44) of chemical and 37.8% (n = 58) of tympanic readings might have resulted in patients receiving unnecessary interventions. Conclusions. The chemical thermometer was more accurate, reliable and associated with fewer clinically significant temperature differences compared with the tympanic thermometer. However, compared with the pulmonary artery catheter both methods were associated with erroneous readings. In the light of these findings and previous research evidence, it is becoming increasingly difficult to defend the continued use of tympanic thermometry in clinical practice. However, as chemical thermometers are not without their limitations, further research needs to be undertaken to evaluate the accuracy and reliability of other non‐invasive methods. Relevance to clinical practice. Chemical and tympanic thermometers are used in both adults and children in a wide variety of settings ranging from community to intensive care. As such these findings have significant implications for patients, users and budget holders.     

不同方法测量患儿体温的比较

目的探讨在临床上应用红外鼓膜体温计（简称耳温计）测量体温的可行性。方法按便利抽样法抽取2008年9月至2009年5月某院儿科住院患儿860例,用耳温计测量患儿耳温,同时用水银体温计测量患儿腋温、肛温。采用自身对照的方法比较3种方法测量体温的数值及测量时间的差异,并对结果进行统计学分析。结果通过对患儿的耳温和腋温、肛温的随机区组间的方差分析比较,发现3种方法所测温度的差异有统计学意义（P〈0.05）。进一步比较发现,耳温与肛温之间的差异无统计学意义（t1=-0.138,P〉0.05）,但耳温与腋温、腋温与肛温之间的差异均有统计学意义（t2=-0.0360,t3=-0.0498,均P〈0.05）。测量腋温、耳温、肛温所耗时间分别为10min、3s、3min。结论耳温计可以代替水银体温计测量体温,且更省时、更安全。     

Branch Reports

ABSTRACT:

This study investigated the accuracy of two animal specific non-contact infrared thermometers (Rycom and Thermofocus) when compared to rectal temperature in healthy horses. One hundred rectal and eye temperatures were measured in 22 horses. Fewer than 50% of the readings taken with the Thermofocus device were within ±?0.5°C of rectal temperature. Over 80% of eye temperature readings taken with the Rycom device were within ±?0.5°C of rectal temperature measured from the medial canthus region. The Rycom thermometer also appears to detect hyperthermia when measuring the left eye temperature; however, clinical patient testing is needed before its use can be recommended.     

Are electronic thermometry techniques suitable alternatives to traditional mercury in glass thermometry techniques in the paediatric setting?

Are electronic thermometry techniques suitable alternatives to traditional mercury in glass thermometry techniques in the paediatric setting? ¶Three thermometers, mercury in glass, Becton-Dickinson digital and IVAC tympanic membrane thermometer, were compared. The study was designed to test the null hypothesis that there is no difference between the thermometer recordings, meaning that electronic thermometry is a suitable alternative to traditional mercury in glass thermometry. Children aged between 0 and 15 years old were entered into the study, n = 114. Standard procedures were used throughout the study to minimize the risk of errors in the data collection and technical errors were recorded. The data were analysed using graphical techniques described by Bland and Altman. The differences between the temperature recordings were plotted against their mean (the estimated true value), with the bias and limits of agreement (2 standard deviations from the mean) calculated for the mercury in glass/digital, mercury in glass/tympanic and digital/tympanic temperature recordings. The range of temperatures were 35·1°C–38·5°C, with a mean of 36·85°C for the mercury in glass thermometer, 36·8°C for the digital thermometer and 36·65°C for the tympanic thermometer. The bias for each comparison was 0·36°C, 0·21°C and 0·17°C and the limits of agreement were wide, ?0·516°C to 1·234°C, ?0·84°C to 1·252°C and ?0·94°C to 1·244°C for the mercury in glass/digital, mercury in glass/tympanic and digital/tympanic recordings respectively. A difference of 0·2°C is usually accepted for clinical practice, therefore the null hypothesis was rejected.     

Reliability of body temperature measurements in hospitalised older patients

Aims and objectives. To compare different body temperature assessment methods in older people and to assess the role of cognitive and functional characteristics in temperature recordings. Background. Axillary gallium‐in‐glass thermometers are commonly used. Their accuracy depends on the proper placement of the device and their permanence in place for eight minutes. With adequate instruction, well‐functioning patients can measure their axillary temperature by themselves, while in cognitively and functionally impaired older people, inadequate understanding of instructions and misplacement of the thermometer might determine significant recording errors. Electronic ear and axillary temperature measurements are faster, but their accuracy has not been demonstrated convincingly with older people. Methods. Patients (n = 107; aged 65–104 years) were recruited. Barthel Index and Short Portable Mental Status Questionnaire (SPMSQ) scores were obtained for each patient. Temperature readings were obtained using: the axillary gallium‐in‐glass thermometer, with (T_nurse) and without (T_self) the nurse's assistance; the electronic axillary thermometer (T_el) and the infrared tympanic thermometer (T_tymp). The T_nurse was considered as the reference method. Results. Mean difference and standard deviation (mean ± SD) in temperature recordings between the different techniques and T_nurse differed significantly from zero for T_self (?0·40 SD 0·42) and T_tymp (+0·19 SD 0·48). No significant differences in temperature recordings emerged between T_nurse and T_el. In simple linear regression models, the difference between T_self and T_nurse significantly correlated with age, gender, SPMSQ score and Barthel Index. Multiple linear regression analysis showed an underestimation of body temperature in older patients with cognitive impairments. Conclusion. Unassisted gallium‐in‐glass axillary temperature assessment is inadequate, in older patients. The differences between T_self and T_nurse are significantly influenced by age and mental decline. T_el provides adequate accuracy. Relevance to clinical practice. In geriatric settings, the electronic axillary thermometer is a safe and accurate alternative to the more traditional gallium‐in‐glass thermometer, with the advantage of saving time (five seconds in recording vs. eight minutes).     

Does the body temperature change in older people?

Aim. The aim of this study was to determine the mean body temperatures in older people using mercury‐in‐glass thermometer. Background. Older people are unable to regulate their body temperatures to the same degree as young adults because their responses to changes in body temperature are altered. Several published reports suggest that body temperature decreases with advancing age and has a greater variability in older populations. The aim of this study was to determine the mean body temperatures in older people. Design. Non‐experimental. Methods. Axillary body temperatures were taken in 133 older subjects in a nursing home for older people using mercury‐in‐glass thermometer. Temperatures were measured at 8 a.m., 2 p.m., and 6 p.m., over three consecutive days. Each subject had all three measurements taken on the same day. Results. The mean age of the subjects was 77·2, SD 7·3. In the 133 older subjects, the mean axillary temperatures ranged from 35·1 to 36·4 °C (95·3–97·6 °F). The mean temperatures for those aged 65–74 was higher than in those aged 75–84 (p < 0.001) and those aged 85 and older (p < 0·001) at 6 p.m. but not at 8 a.m. or 2 p.m. We concluded that older people have mean axillary body temperatures lower than the reference point of 36·5 °C (97·7 °F). Relevance to clinical practice. When assessing body temperature, it is important to take the age of the patient into consideration. Also, the reference point of 36·5 °C is inappropriate in older people, especially when diagnosing a febrile illness.     

A comparison of four methods of normal newborn temperature measurement

PURPOSE: The purpose of this study was to: (a) compare newborn temperature measurements obtained by digital disposable, electronic, and tympanic thermometers with glass mercury thermometers, and (b) compare financial implications of each method. METHODS: In this correlational study, 12 perinatal and neonatal nurses obtained temperature measurements of 184 newborns between 1 and 168 hours of age. The stratified convenience sample was selected using medical records numbers. Temperature instruments included glass thermometer, tympanic thermometer, electronic thermometer, and a digital thermometer. Data were analyzed by Pearson r coefficients, mean, standard deviation, and range using an SPSS statistical package. RESULTS: The glass thermometer, electronic thermometer, and digital thermometer temperature assessments were highly correlated (0.748-1.0). The tympanic thermometer had a low correlation coefficient (0.35). Use of the glass thermometer had the highest accompanying cost. Tympanic thermometers were the most cost effective. CLINICAL IMPLICATIONS: In healthy newborns, the use of electronic and digital thermometers can be encouraged if there is concern about using glass thermometers. These results cannot be extrapolated to sick infants. While tympanic thermometers had the lowest associated cost, their lack of correlation with the gold standard glass thermometers for accurate temperature assessment makes them a poor choice for healthy newborns.     

水银体温计测量腋窝体温放置时间的研究及其Meta分析

目的 比较腋窝测量体温时水银体温计放置5 min与10 min所得体温值有无差别.方法 用方便抽样的方法抽取右江民族医学院附属医院住院患者365例,用同一支体温计连续测量同侧腋窝温度5 min与10 min,对测量结果进行比较.检索各数据库,获取相关研究数据,用Meta分析的方法对纳入研究的6篇文献进行分析.结果 在α=0.05水准上,用配对t检验对测量腋温5 min与10 min所得体温值进行检验,差异显著;Meta分析的结果也证明两者差异显著.用365例受试者的体温数据做出的Bland-Altman图显示,2种测量时间所得体温值的差异在临床上不可接受.结论 用水银体温计测腋温时体温计放置时间应持续10 min更为科学.     

An evaluation of tympanic thermometry in a paediatric emergency department

Background and objectives

The consequences of missing fever in children can be grave. Body temperature is commonly recorded at the axilla but accuracy is a problem. This study aimed to evaluate the accuracy of a tympanic thermometer in the paediatric emergency setting.

Method

In a total of 106 infants, the body temperature was measured in the daytime with an infrared tympanic thermometer, and at the axilla with an electronic thermometer and at the rectum (gold standard for measurement of body temperature). Fever was defined as a rectal temperature of 38.0 °C or greater, axillary temperature of 37.5 °C or greater, and tympanic temperature of 37.6 °C or greater. The temperature readings at the three sites were compared statistically.

Results

There was a greater correlation of the tympanic measurement with the rectal measurement than the axillary with the rectal in both febrile and afebrile infants. The mean difference between the tympanic and rectal measurements was lower than that between the axillary and rectal measurements in both groups of infants (tympanic 0.38 °C and 0.42 °C, and axillary 1.11 °C and 1.58 °C, respectively). Tympanic measurements had a sensitivity of 76% whereas axillary measurements had a sensitivity of only 24% with rectal temperatures of 38–38.9 °C.

Conclusion

Tympanic thermometry is more accurate than measurement of tempeature with an electronic axillary thermometer. It is also quick and safe, and thus it is recommended in the paediatric emergency setting.     

3种体温计测量体温效果分析

目的探讨3种体温计测量体温效果,寻找一种准确、快捷、安全的体温测量方法。方法采用方便取样法,选择在本院产科住院产妇共1500例,分别应用汞式体温计测量腋下体温、电子体温计测量耳腔温度、非接触红外线体温计测量体表温度,每例产妇均应用3种方法测体温,合计4500次。比较3种测量方法的测温效果、所花费的时间。结果 3种方法体温测量值比较,差异具有统计学意义(P<0.05);其中汞式体温计与电子体温计测量值比较,差异无统计学意义(P>0.05),非接触红外线体温计与其他两种方法测量值比较,差异具有统计学意义(均P<0.05),非接触红外线体温计比汞式体温计及电子体温计测量值低;非接触红外线体温计与汞式体温计呈直线正相关。结论临床使用电子体温计测量体温是准确、安全、有效的,并可节省临床护理时间及减少汞对环境污染的危险性,优于汞式体温计测量体温。     

Establishing a reference range for normal canine tympanic membrane temperature measured with a veterinary aural thermometer

Studies have shown that tympanic membrane temperature (TMT) under-reports body temperature when compared to rectal temperature. This could lead to misinterpretation of the TMT, if comparing the result to a rectal temperature range. The aim of this study was to establish a normal canine TMT reference range. Four hundred and sixteen TMTs were taken from 157 healthy dogs, in a range of ambient temperatures. The normal reference range for canine TMT was found to be 36.6–38.8°C. This range should be considered by pet owners and veterinary professionals when interpreting TMT measured with a veterinary aural thermometer, to avoid misinterpretation of the results.     

Use of non-contact infrared thermometers in rehabilitation patients: a randomized controlled study

ObjectiveIn this randomized controlled study, we aimed to determine whether non-contact infrared thermometers (NCITs) are more time-efficient and create less patient distress than mercury axillary thermometers (MATs) and infrared tympanic thermometers (ITTs).MethodsForty-five rehabilitation inpatients were randomly assigned to one of three groups (NCIT, MAT, and ITT). Time required to measure body temperature with an NCIT, MAT, and ITT was recorded. We examined associations between time required to take patients’ temperature and measuring device used. Patient distress experienced during temperature measurement using the three thermometers was recorded.ResultsA significantly longer average time was required to measure temperatures using the MAT (mean 43.17, standard deviation [SD] 8.39) than the ITT (mean 13.74, SD 1.63) and NCIT (mean 12.13, SD 1.18). The thermometer used influenced the time required to measure body temperature (t = 33.99). There were significant differences among groups (NCIT vs. ITT, NCIT vs. MAT, and ITT vs. MAT) regarding patient distress among the different thermometers. Most distress arose owing to needing help from others, sleep disruption, and boredom.ConclusionThe NCIT has clinically relevant advantages over the ITT and MAT in measuring body temperature among rehabilitation patients, including saving nurses’ time and avoiding unnecessary patient distress.Clinical trial registration number (http://www.chictr.org.cn): ChiCTR1800019756.     

红外线体温测量仪不同部位测量结果与实际体温的差异比较

目的 寻找一种简单准确、损伤小的测量体温的方法。方法 随机抽取正常人和门诊患者共计349例,分别用水银体温计测量腋温,用红外线体温测量仪测量前额温度和内关温度。结果 红外线体温测量仪测量结果与腋温值有一定差异,内关温与实际腋温的偏差小于前额温。结论 用红外线测量仪测量内关也可作为一种简单易行的筛查发热患者的方法。     

Pediatric temperature measurement and child/parent/nurse preference using three temperature measurement instruments

This study compared the tympanic thermometer with the electronic and chemical dot thermometers used at the axillary site and evaluated child, parent, and nurse preferences for method of temperature measurement. The child's (n = 146) temperature was measured using each of the three methods. Each child, parent, and nurse was asked to select a preference for device and site. Results were analyzed using the Bland-Altman method. Results showed that most of the paired readings fell within the Bland-Altman limits of agreement (LOA). When the chemical dot and tympanic temperature readings were compared with the electronic axillary reading, the tympanic thermometer was found to be in closer agreement. The chemical dot thermometer placed in the axilla consistently read higher than the electronic thermometer in the same site. Children, parents, and nurses preferred the tympanic thermometer.     

Comparison of temporal artery to mercury and digital temperature measurement in pediatrics

AimThe aim of the study was to compare the temporal artery thermometer measurements with the mercury and digital axillary thermometer measurements in children.MethodsThis study was conducted at the Pediatric Emergency Department of Akdeniz University Hospital over a three-month period in Turkey. The sample for the study comprised 218 children (aged 0–18 years). Three different methods were applied to each patient at the same time. After acquiring necessary institutional permission to conduct the study, the informed consent to participate was obtained from parents before the subjects were included in the study. The data were evaluated using general linear models. The differences between the groups were analyzed by Least Significant Difference method.ResultsThe average temperature measured by temporal artery, mercury and digital thermometers were 38.9 °C, 38.3 °C and 38 °C respectively.ConclusionTemporal artery thermometer values might be considered as core temperature. Rectal temperature is about 2 °F (1 °C) higher than an axillary temperature. In our study the difference between the temperature measured values was found to be consistent with the range provided in the literature. Temporal artery thermometers are recommended especially pediatric emergency settings, where an accurate, quick and safe body temperature measurement is of vital importance.     

The Accuracy of Oral Predictive and Infrared Emission Detection Tympanic Thermometers in an Emergency Department Setting

OBJECTIVE: To assess the accuracy of an oral predictive thermometer and an infrared emission detection (IRED) tympanic thermometer in detecting fever in an adult emergency department (ED) population, using an oral glass mercury thermometer as the criterion standard. METHODS: This was a single-center, nonrandomized trial performed in the ED of a metropolitan tertiary referral hospital with a convenience sample of 500 subjects. The temperature of each subject was taken by an oral predictive thermometer, an IRED tympanic thermometer set to "oral" equivalent, and an oral glass mercury thermometer (used as the criterion standard). A fever was defined as a temperature of 37.8 degrees C or higher. The subject's age, sex, triage category, and diagnostic group were also recorded. Sensitivity, specificity, positive and negative likelihood ratios, positive and negative predictive values, and corresponding 95% confidence intervals were calculated. Logistic regression was used to identify predictors of fever. RESULTS: The sensitivities and specificities for detection of fever of the predictive and the IRED tympanic thermometers were similar (sensitivity 85.7%/88.1% and specificity 98.7%/95.8%, respectively). The predictive thermometer had a better positive predictive value (85.7%) compared with the IRED tympanic thermometer (66.1%). The positive and negative likelihood ratios for the predictive oral thermometer were 65 and 0.14, respectively, and for the IRED tympanic thermometer 21 and 0.12, respectively, indicating that the predictive thermometer will "miss" 1 in about 7 fevers and the IRED tympanic thermometer will "miss" 1 in about 8 fevers. CONCLUSIONS: Although quick and convenient, oral predictive and IRED tympanic thermometers give readings that cannot always be relied on in the detection of fever. If we are to continue using electronic thermometers in the ED setting, we need to recognize their limitations and maintain the importance of our clinical judgment.     

Evaluation of commercial,wireless dermal thermometers for surrogate measurements of core temperature

Extensive research has been devoted to developing methods for assessing core body temperature, and to determine which method is most accurate. A number of wireless dermal thermometers for home use are presently available, but their relation to core body temperature and suitability for use in clinical research has hitherto not been assessed. The current study aimed to evaluate such thermometers by comparing them to the results of a rectal thermometer. Four wireless dermal thermometers for home use (FeverSmart, iThermonitor, Quest Temp Sitter, and Thermochron iButton) were applied to 15 patients during 24?h, and rectal temperature was measured at four occasions. Pearson correlation revealed moderate correlation for the Feversmart (r?=?0.75), iThermonitor (r?=?0.79), and Thermochron iButton (r?=?0.71) systems. The Quest Temp Sitter system malfunctioned repeatedly, and the correlation (r?=?0.29) for this method should therefore be assessed with caution. All dermal thermometers rendered lower average temperatures than Terumo c405 (Feversmart ?0.70?±?0.65?°C; iThermonitor ?0.77?±?0.53?°C, Quest Temp Sitter ?1.18?±?0.66?°C, and Thermochron iButton ?0.87?±?0.65?°C). Sensitivity of the dermal thermometers for detecting core temperatures ≥38.0?°C was low, ranging from 0.33 to 0.6, but improved to 0.60 to 0.80 after adjusting temperatures by the methods’ average deviation from rectal temperature. The results from the dermal thermometers tested here showed an insufficient correlation to core temperature to be used for core temperature monitoring in clinical research and practice. Unfortunately, other options for non-invasive temperature measurements are few. The two thermometers with the least unsatisfactory performance profile in our evaluations were the Feversmart and iThermonitor systems.     

电子体温计在儿科陪护病房的应用

目的探讨电子体温计在儿科陪护病房的应用效果,以期为临床电子体温计的推广应用提供科学依据。方法 2011年4-6月,便利抽样法抽取在上海市儿童医院需测量体温的652例患儿为研究对象,用电子体温计测量左侧腋温,同时用水银体温计测量其右侧腋温和肛温。结果通过对患儿的两侧腋温和肛温之间的随机区组间方差分析比较发现,3种测量法所测量的温度的差异有统计学意义(P0.05)。进一步比较发现,两侧腋温之间的差异无统计学意义(t1=0.770,P0.05);但腋温和肛温之间的差异有统计学意义(t2=-12.054,t3=-15.174,P0.05)。水银温度计测量腋温和肛温的时间分别为10min和3min;而电子温度计测量腋温一般为1~2min。水银体温计临床使用2%含氯制剂浸泡消毒2次(5min、30min),电子体温计使用75%乙醇擦拭表面即可达到消毒。结论使用电子体温计测量体温,数据可靠,操作简便,可作为临床监测体温的工具之一,但使用时需加强监督管理。