Comparison of Temporal Artery Thermometry with Axillary and Rectal Thermometry in Full Term Neonates

Objective

To assess the efficacy of temporal artery thermometer in febrile and hypothermic neonates in comparison to axillary thermometer.

Methods

It was a cross sectional observational study. Study participants included 210 neonates admitted in neonatal intensive care unit of a tertiary care teaching hospital, divided into three groups of 70 each, namely normothermic, febrile and hypothermic. Temperatures were measured using temporal artery, axillary and rectal thermometers in each patient.

Results

Mean rectal temperature was found to be comparable to mean temporal artery temperature in normothermic babies. Temporal artery thermometer had a better sensitivity to diagnose fever, than hypothermia. Also, temporal artery temperature showed a good correlation with rectal temperature in normothermic and febrile group and not in hypothermic neonates.

Conclusions

Temporal artery thermometer can accurately detect temperature in febrile and normothermic fullterm neonates but not in hypothermic neonates. Further studies are required before advocating temporal artery thermometry as a replacement of rectal thermometry among this group of population.

     

Infrared tympanic thermometry in comparison with other temperature measurement techniques in febrile children.

OBJECTIVE:: To determine whether infrared tympanic thermometry (ITT) measurements more accurately reflect core body temperatures than axillary, forehead, or rectal measurements during fever cycles in children. DESIGN:: Prospective cohort study. SETTING:: Pediatric and cardiac intensive care units at a tertiary care children's hospital. PATIENTS:: Critically ill children <7 yrs of age with indwelling bladder catheters. INTERVENTIONS:: Simultaneous temperatures were recorded during both febrile and nonfebrile periods using ITT, indwelling bladder (core), axillary, forehead, and indwelling rectal measurements in 36 children. MEASUREMENTS AND MAIN RESULTS:: Overall ITT measurements were 0.03 +/- 1.43 degrees F less than core temperature measurements. In comparison, rectal, forehead, and axillary measurements averaged 0.62 +/- 1.44, 0.56 +/- 1.81, and 1.25 +/- 1.73 degrees F less than core temperature measurements. ITT measurements had better agreement with core measurements during increasing and decreasing temperature cycles. Receiver operating characteristic analysis performed on increasing and decreasing temperature cycle data revealed that ITT measurements performed well, with an area under the curve of 0.855 (95% confidence interval, 0.797-0.913) in comparison with rectal measurement area under the curve of 0.777 (95% confidence interval, 0.701-0.853), forehead measurement area under the curve of 0.710 (95% confidence interval, 0.715-0.888), and axillary measurement area under the curve of 0.664 (95% confidence interval, 0.579-0.750). CONCLUSIONS:: ITT measurements more accurately reflect core temperatures than any other measurement site during febrile and nonfebrile periods in children. ITT measurements are a reproducible and relatively noninvasive substitute for bladder or rectal measurements in febrile children.     

Limited accuracy and reliability of infrared axillary and aural thermometers in a pediatric outpatient population

OBJECTIVE: To evaluate the accuracy and reliability of infrared axillary and aural thermometers in the outpatient setting. STUDY DESIGN: A prospective observational study of infrared axillary, aural, and digital rectal temperature values from 198 children, aged 3 to 36 months (mean, 1.3 years). RESULTS: Sensitivity and specificity of the axillary thermometer for rectal fever were 63.5% and 92.6%, respectively (diagnostic accuracy, 83.3%); those for the aural thermometer were 68.3% and 94.8%, respectively (diagnostic accuracy, 86.4%). For all patients, the mean biases of the axillary and aural temperatures were -0.33 degrees F and -0.24 degrees F, respectively. The biases of both thermometers' measurements were significantly correlated with rectal temperature (P <.02); thus, as rectal temperature increased, the accuracy of the compared axillary and aural temperature decreased. Underestimation of rectal temperature was greatest among febrile 1- to 3-year-old children (axillary bias, -1.20; aural bias, -0.36). Age was correlated with an axillary temperature bias (P <.01). CONCLUSION: Axillary and aural infrared thermometers were comparable, albeit significantly different than rectal temperature measurements, particularly as the child's age and rectal temperature increased. These thermometers may be useful as noninvasive screening methods in outpatient settings for children who are at least 3 months old, but rectal values should be used for clinical accuracy.     

Accuracy of a noninvasive temporal artery thermometer for use in infants

OBJECTIVES: To assess the accuracy of a new noninvasive temporal artery (TA) thermometer in infants; to compare the accuracy of the TA thermometer with that of a tympanic thermometer, using rectal thermometry as the criterion standard; and to compare the tolerability of the TA thermometer with that of the tympanic and rectal thermometers. DESIGN: Prospective evaluation of the accuracy of TA and tympanic thermometry, using rectal thermometry as the criterion standard. SETTING: Emergency department of an urban pediatric hospital. SUBJECTS: Convenience sample of 304 infants younger than 1 year presenting for care. MAIN OUTCOME MEASURES: Temperatures were measured using TA, tympanic, and rectal thermometers for all infants. Agreement between TA or tympanic and rectal temperatures was assessed. The sensitivity and specificity of TA or tympanic thermometers for detecting rectal fever were determined. Discomfort scores, using a standardized scale, were assessed by trained observers after each temperature measurement was made. RESULTS: Linear regression analysis of the relation between TA and rectal temperatures yielded a model with a slope of 0.79 (vs a slope of 0.68 for tympanic vs rectal temperature; P =.02) and an r of 0.83 (vs r = 0.75 for tympanic vs rectal temperature; P<.001). Among 109 patients with a rectal temperature of 38 degrees C or higher, the TA thermometer had a sensitivity of 0.66 compared with the tympanic thermometer's sensitivity of 0.49 (P<.001). Discomfort scores with TA thermometry were significantly lower than with rectal thermometry (P =.007). CONCLUSIONS: The TA thermometer has limited sensitivity for detecting cases of rectal fever in infants. However, the TA thermometer is more accurate than the tympanic thermometer in infants, and it is better tolerated by infants than rectal thermometry.     

Modern electronic and chemical thermometers used in the axilla are inaccurate

Rectal and axillary temperatures were measured simultaneously in 83 children using three different thermometer devices providing 166 pairs of results. In the first series consisting of 22 febrile children (44 measurements) and 20 afebrile children (40 measurements), the rectal mercury measurement was compared to an axillary mercury and axillary Tempa-DOT thermometer. The axillary mercury had sensitivity of 14/22 (64%) and specificity of 20/20 (100%) while the Tempa-DOT had sensitivity of 15/22 (68%) and specificity of 19/20 (95%). In the second series comprising 21 febrile children (42 measurements) and 20 afebrile children (40 measurements) the axillary mercury had sensitivity of 11/21 (52%) and specificity of 20/20 (100%) while the electronic thermometer had sensitivity of 10/21 (48%) and specificity of 20/20 (100%). Regardless of the thermometer used , the axilla is a poor alternative to rectal measurements in the diagnosis of fever. Conclusion Mercury-free thermometers, when used in the axilla are as poor alternatives to rectal measurements as mercury-in-glass thermometers. Received: 14 November 1995 Accepted: 5 March 1996     

The inaccuracy of axillary temperatures measured with an electronic thermometer

Temperatures were measured using an electronic thermometer in an emergency department to determine the relationship between oral or rectal and axillary measurements. A total of 164 data pairs were obtained--95 in afebrile children, and 69 in febrile children. The correlation coefficient was .74 for oral-axillary pairs, and .70 for rectal-axillary pairs. The mean difference between oral and axillary temperatures was 1.17 degrees C +/- 0.72 degrees C, and between rectal and axillary temperatures was 1.81 degrees C +/- 0.97 degrees C. Using 37.4 degrees C (greater than or equal to 2 SDs) axillary as the upper limit of normal, the sensitivity, specificity, and positive and negative predictive values were calculated for detecting a fever. The sensitivity was 46%; specificity, 99%; positive predictive value, 97%; and negative predictive value, 72% for combined oral-axillary and rectal-axillary data. It was concluded that axillary temperatures are not sensitive enough to determine a fever when measured with an electronic thermometer. Electronic thermometers should be used to determine oral or rectal temperatures; axillary temperatures may be misleading and should be abandoned in the outpatient setting.     

When body temperature changes, does rectal temperature lag?

By using temporal artery and rectal thermometers, we followed temperatures in 45 febrile (>38.5 degrees C) infants given an antipyretic drug. Sixty and 90 minutes after drug administration, temporal artery temperatures had decreased significantly more than rectal temperatures. When body arterial temperature changes rapidly, changes in rectal temperature may lag.     

Temporal artery temperature measurements in healthy infants,children, and adolescents

A noninvasive temporal artery thermometer that uses arterial heat balance technology has been compared to rectal and ear thermometry and is available in the marketplace. This study was undertaken to establish mean temperatures and temperatures 2 standard deviations above the mean for healthy infants, children, and adolescents. Temperatures were measured in healthy patients 0 to 18 years of age using a noninvasive temporal artery thermometer. Temperatures were measured in 2,346 patients. Mean temperatures and temperatures 2 standard deviations above the mean were: 37.1 degrees C (38.1 degrees C) for 383 infants 0 to 2 months; 36.9 degrees C (37.9 degrees C) for 860 children 3 to 47 months; 36.8 degrees C (37.8 degrees C) for 680 children 4 to 9 years; and 36.7 degrees C (37.8 degrees C) for 423 adolescents 10 to 18 years. There were no significant differences in temperatures in white compared to African-American children, children with or without perspiration on their forehead, or between measurements taken on the left compared to the right side of the forehead. This study provides information about temporal artery temperatures in healthy infants and children that can serve as a basis for interpreting temperature measurements in ill children when the same instrument is used.     

How reliable is axillary temperature measurement?

AIM: To assess whether axillary temperature measurements reliably reflect oral/rectal temperature measurements. METHODS: This observational study compared paired axillary-rectal and axillary-oral temperatures in a general paediatric ward with the participation of 225 children aged < or = 4 y and 112 children aged between 4 and 14 y. RESULTS: Changes in oral/rectal and axillary temperatures correlated significantly (p < 0.0001). However, axillary temperature measurements were significantly lower than both oral (mean -0.56 degrees C, SD 0.76 degrees C) and rectal measurements (0.38 degrees C; SD 0.76 degrees C). Ninety-five percent of axillary measurements fell within a 2.5-3 degrees C range around respective paired oral/rectal measurements. The mean difference increased with increasing temperature, and was 0.4 degrees C at low body temperatures, and over 1 degree C with a fever of 39 degrees C. Neither seasonal fluctuations nor the amount of clothing worn influenced this difference. CONCLUSION: Axillary temperatures in young children do not reliably reflect oral/rectal temperatures and should therefore be interpreted with caution.     

Continuous haemodynamic monitoring in children: use of transoesophageal Doppler

A wide range of invasive and non-invasive techniques for monitoring the haemodynamic condition of critically ill patients is now available. A general reluctance on the part of paediatric intensive care specialists to use pulmonary artery thermodilution catheters and the need for constant realignment of hand-held Doppler probes has necessitated the search for a technique which is relatively non-invasive and provides continuous information on the haemodynamic condition of critically ill paediatric patients. We sought to establish if transoesophageal Doppler fulfilled these criteria. Eleven children who had recently undergone cardiac surgery were studied. Median age was 39 months and weight 14.9 kg. Five simultaneous pairs of measurements of cardiac index (CI: thermodilution) and minute distance (MD: transoesophageal Doppler) were made, as a baseline, when each child was haemo-dynamically stable. Following a fluid challenge, five repeat pairs of measurements were made. The mean percentage changes for CI and MD were 16.4% (range 5.3-44%) and 16.6% (3.4-47.7%), respectively. The average coefficients of variation for measurements of CI and MD were 3.5% and 2.9%, respectively. The mean difference in percentage change between CI and MD was -0.5% (95% confidence interval for the bias –4% to 3%; limits of agreement –10.7 to +9.7%). Our study indicates that transoesophageal Doppler is reproducible, easy to use and provides clinically acceptable information when following changes in CI in haemodynamically stable paediatric patients. ? Cardiac index, minute distance, pulmonary artery catheter, thermodilution, transoesophageal Doppler     

Comparison of tympanic and rectal temperature in febrile patients

Objective. To compare tympanic membrane temperature and rectal temperature in febrile pediatric patients.Methods. Sixty febrile children were enrolled as continuous enrollment at initial triage. Two readings of ear temperature were taken in each child with Thermoscan infrared thermometer. Rectal temperature was recorded by a digital electronic thermometer. Comparison of both the techniques was done and co-relation co-efficients calculated. Parental preference for both techniques was assessed.Results. It was observed that mean ear temperature was 38.9±0.90C and that for rectal temperature was 38.8±0.8°C. The correlation coefficient between the two was 0.994 (p < 0.01). Coefficients for both sites were comparable over a wide age range. The difference between readings taken from two ears was not significant. Temperature ranges over which readings were recorded were quite wide for both techniques. Parental preference for tympanic thermometry over rectal thermometry was noticed. Tympanic thermometry utilizes pyro-electric sensors, to detect infra-red rays emitted from the surface of tympanic membrane. Ear temperatures correlates well with rectal temperatures which have long been considered as “core” temperatures. Parents prefer the technique of ear thermometry which is quick (2 sec), safe and non-invasive and patient resistance for this is also less.Conclusion. A non-invasive, non-mucous device which is accurate over a wide range of temperature could be very useful.     

Is axillary temperature an appropriate surrogate for core temperature?

The ideal technique for measuring temperature should be rapid, painless, reproducible and accurately reflect the core temperature. While axillary temperature is commonly used because of convenience and safety, there are conflicting reports abouts its accuracy. To determine whether axillary temperature can act as a surrogate for oral/rectal temperatures, a prospective comparative study was conducted. The axillary and rectal temperatures (Group 1: infants < 1 year age) and axillary and oral temperatures (Group 2: children 6–14 years age) were compared using mercury-in-glass, thermometers. Various tests of agreement were applied to the data obtained. Rectal and axillary temperatures for infants agreed well; the mean difference (95% limits of agreement) between the two being 0.6°C (−0.3°C, 1.4°C). Similarly, the mean difference (95% limits of agreement) between oral and axillary measurements for children aged 6–14 years was observed to be 0.6°C (−0.4°C, 1.4°C). Axillary temperature appears to be an acceptable alternative to rectal/oral temperature measurements in children.     

Comparison of temporal artery, rectal and esophageal core temperatures in children: Results of a pilot study

BACKGROUND:

Rectal thermometry correlates with core temperature and represents the criterion standard of measuring temperatures in young children. However, it has numerous disadvantages, and thus, an alternative method of measuring temperature with similar agreement with the core temperature as rectal thermometry is desired. A new, noninvasive temporal artery (TA) thermometer synthesizes the skin surface and ambient temperatures to produce an arterial temperature.

OBJECTIVE:

To examine the agreement between the TA and esophageal core thermometers, and to compare it with that between rectal and esophageal temperatures.

METHODS:

In the present prospective, cross-sectional agreement study, intubated surgical outpatients younger than 18 years of age had temperatures measured with esophageal and rectal probes, and rectal electronic and TA thermometers. The agreement between esophageal versus rectal and TA thermometers was analyzed by intraclass correlation coefficients and by differences between esophageal versus TA and rectal temperatures with 95% CIs. The esophageal-rectal and esophageal-TA slopes were compared by Student’s t test.

RESULTS:

In 80 enrolled children, the intraclass correlation coefficients for the esophageal probe versus rectal probe, rectal electronic thermometer and TA thermometer were 0.91, 0.95 and 0.88, respectively. The mean esophageal-rectal difference was 0.00±0.18°C and esophageal-TA difference was 0.14±0.20°C. Linear regression analysis of the relation between esophageal probe versus rectal probe, rectal thermometer and TA thermometer yielded slopes of 0.93, 0.94 and 0.89, respectively. The slopes were neither different from each other (P=0.70) nor from the value of 1.

CONCLUSION:

The TA and esophageal thermometers agree well, and the esophageal-TA and esophageal-rectal temperature agreements are not significantly different.     

A probability nomogram to predict rectal temperature in children.

The relationship between rectal and peripheral-site temperature was investigated to achieve two objectives: 1) to evaluate a prevailing practice of intersite adjustment by use of an invariant temperature difference; and 2) to develop a statistical method for intersite temperature predictions in the individual child, especially for fever as defined by rectal measurement. Rectal, oral, axillary, left abdomen skin, and forehead skin temperatures (degrees F) were measured with an electronic thermometer in 257 children. Objective 1 was not achieved because a simple temperature difference between a peripheral site and the rectal site could not be used to predict rectal temperature reliably. For objective 2, intersite differences met three statistical criteria so that normal distribution theory could be used to derive the probabilities for occurrence of each difference. Accordingly, cumulative probability nomograms were constructed to estimate rectal-site fever from measurements at peripheral sites. This nomogram method produces a clinically reliable prediction of rectal-site fever from temperature measurement at peripheral sites, especially the oral and axillary sites. These predictions offer useful assessments of febrile illness severity when rectal temperature is not available.     

Axillary and rectal temperature measurements in infants.

Rectal and axillary temperatures were measured during the daytime in 281 infants seen randomly at home and 656 at hospital under 6 months old, using mercury-in-glass thermometers. The normal temperature range derived from the babies at home was 36.7-37.9 degrees C for rectal temperature and 35.6-37.2 degrees C for axillary temperature. Rectal temperature was higher than axillary in 98% of the measurements. The mean (SD) difference between rectal and axillary temperatures was 0.7 (0.5) degrees C, with a range of 3 degrees C. When used in hospital to detect high temperature, axillary temperature had a sensitivity of 73% compared with rectal temperature. This is too insensitive for accurate detection of an infant's high temperature. Rectal temperature measurement is safer than previously suggested: perforation has occurred in less than one in two million measurements. If an infant's temperature needs to be taken, rectal temperature should be used.     

Comparison of tympanic and rectal temperatures in febrile children

The present study was designed to assess the accuracy of tympanic membrane temperature (TMT) in predicting "core" body temperature and to compare rectal temperature (RT) and TMT in febrile pediatric patients with and without meningitis. Sixty children diagnosed as having meningitis by cerebro-spinal fluid (CDF) analysis formed the cases and 60 non-meningitic febrile patients, chosen as continuous enrollment, formed the controls. Rectal and ear temperatures were assessed in both groups. Ear temperature was significantly higher in cases as compared to controls. The difference between reading of ear temperature and rectal temperature was also significantly higher in cases as compared to controls. Significant correlations were seen between ear temperature and various parameters of CSF profile.     

Infrared thermometry of newborn infants

An infrared thermometer, the FirstTemp, was tested among newborn infants by comparing tympanic membrane temperature measurements in three operating modes, "Cal-tympanic," "Cal-surface," and "Cor-tympanic," with nearly simultaneous tympanic membrane, rectal, and axillary temperature measurements using other standard methods. The FirstTemp underestimated other measurements of body temperature in the "Cal-tympanic" mode and overestimated them in the "Cor-tympanic" mode. In the "Cal-surface" mode, the First-Temp readings were significantly lower than tympanic membrane temperatures measured with a thermistor probe and electronic thermometer (mean difference 0.2 degrees C) but not significantly different from rectal or axillary temperatures. According to these results, the FirstTemp can be used reliably in the "Cal-surface" mode but not in the "Cal-tympanic" or "Cor-tympanic" mode. Its speed and ease of operation offer significant advantages over traditional clinical methods of temperature measurement.     

Comparison of ear to rectal temperature measurements in infants and toddlers.

The purpose of this study was to compare arterial heat balance ear temperature measurements to rectal temperatures in infants and children and to determine the ability of the ear thermometer being tested to detect fever. From 12/95 to 2/96, 1,175 pairs of ear and rectal temperature measurements were prospectively obtained from 140 infants and toddlers. The mean rectal temperature was 37.58 degrees C (sd = 0.68) and the mean ear temperature was 37.60 degrees C (sd = 0.85). However, at the low end of the rectal temperature scale, ear temperatures tended to be higher, and at the high end of the rectal temperature scale, ear temperatures tended to be lower. There were 292 readings with a rectal temperature > or = 38.0 degrees C and in 204 (70%) the ear temperature was also > or = 38.0 degrees C. A retrospective analysis of 53 children who became febrile in hospital (ear or rectal temperature > or = 38.0 degrees C) showed that fever was detected first by rectal measurement in seven, by ear measurement in 31 (59%), and by both in 15 (28%). These data indicate that, on the average, rectal and ear temperature measurements are not different. Fever that developed in children after hospitalization was more likely to be first detected by ear than by rectal measurement.     

Viridans streptococcal sepsis: clinical features and complications in childhood acute myeloid leukemia

PURPOSE: Treatment of acute myeloid leukemia (AML) is associated with substantial adverse effects, including neutropenia and infection. Viridans streptococci (VS) are a primary cause of infection and pneumonia in patients with neutropenia. The authors determined the incidence, clinical features, and complications of VS sepsis in children receiving chemotherapy for AML. METHODS: The authors retrospectively reviewed the records of 172 patients treated on their institutional protocols AML91 (n = 95) and AML97 (n = 77) and identified 36 patients who had VS sepsis. RESULTS: The 1-year cumulative incidence of VS sepsis was significantly higher in AML97 than in AML91. Patients with favorable cytogenetic features (ie, t(9;11), t(8;21), or inv(16)) had a significantly higher incidence of infection than did other patients. VS sepsis developed at various times after chemotherapy was initiated, and patients remained febrile for a median of 15 days. Twelve patients (33%) experienced hypotension, 10 (28%) acute respiratory distress syndrome, and 6 (17%) fungal infection. Twenty-three patients (64%) required intensive care, 21 (58%), oxygen therapy, and 7 (19%), vasopressor medications. One patient died of pulmonary aspergillosis after VS sepsis. The 3-year cumulative incidence of aspergillosis was higher in patients with VS sepsis than in those without. CONCLUSIONS: Although antibiotic therapy rapidly resolved VS sepsis, complications associated with this infection remained life-threatening in children receiving chemotherapy for AML.     

Evaluation of tissue saturation as a noninvasive measure of mixed venous saturation in children.

BACKGROUND: Mixed venous saturation (S & OV0456;o2) is an important measurement that helps guide the care of critically ill patients. Invasive S & OV0456;o2 assessment in infants and children is often avoided because of the inherent risks. A noninvasive tissue saturation (S to 2) monitor has recently been developed that uses near-infrared spectroscopy to measure oxyhemoglobin saturation in muscle. In adult and animal studies, S to 2 correlated with oxygen delivery and S & OV0456;o2. There has been no evaluation in pediatric patients. OBJECTIVE: To evaluate tissue saturation as a noninvasive measure of mixed venous saturation in children. DESIGN: A prospective observational study. SETTING: Catheterization laboratory in a tertiary care children's medical center. PATIENTS: We studied 98 children (49 without intracardiac mixing and 49 with intracardiac mixing) 相似文献