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.     

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。     

Correlación de mediciones de temperatura corporal con 3 termómetros: ótico,cutáneo y digital,en niños mexicanos

ObjectiveTo compare body temperature measurements using tympanic, skin and digital axillary thermometers.MethodHospitalized or outpatient children from the General Hospital Celaya, ISSSTE Hospital Clinic and General Hospital No. 4 IMSS, and the pediatric private service in Celaya, Guanajuato, from 1 day of life until 16 years old, were recruited over a one month period, after their parents signed the consent form. The order of each institution was selected by simple randomization. Body temperatures were measured in triplicate using tympanic, skin and digital axillary thermometers.ResultsThe sample consisted of 554 children. The Pearson r between the tympanic and digital axillary thermometers was 0.57 to 0.65, with a positive linear relationship (P<.05); between the skin and the digital axillary thermometers, it was between 0.47 and 0.52 with a positive linearrelationship (P<.05). The intra-observer Kappa for the tympanic thermometer was 0.86, and for the inter-observer was 0.77; for the skin thermometer it was 0.82 and 0.67, respectively, and for the digital axillary thermometer it was 0.86 for intra-observer reliability and 0.78 for inter -observer reliability.ConclusionTympanic and axillary thermometers showed better precision in measuring the body temperature in children than skin thermometers.     

Evaluation of chemical dot thermometers for measuring body temperature of orally intubated patients.

BACKGROUND: Recent research indicates that oral measurement of body temperature is a reliable option in orally intubated patients. In situations such as protective isolation, where dedicated electronic thermometers are not available, are single-use chemical dot thermometers an acceptable alternative? OBJECTIVE: To determine the accuracy of single-use chemical dot thermometers in orally intubated adult patients. METHODS: Subjects included a convenience sample of 85 adult patients admitted to 1 of 2 intensive care units (surgical trauma and neuroscience). For each patient, oral temperatures were measured concurrently (within 5 minutes) with a chemical dot thermometer and an electronic thermometer. The sequence of temperature measurements was alternated with each subsequent patient. Both thermometers were placed in the same posterior sublingual pocket opposite the side of the endotracheal tube. RESULTS: Measurements obtained with electronic and single-use chemical dot thermometers correlated strongly (r = 0.937). With the chemical dot thermometer, body temperature was overestimated in 11.8% of the measurements and underestimated in 10.8% of the measurements by 0.4 degree C or more. The difference between oral temperatures measured with the 2 different thermometers was not related to the patient's age, sex, or sublingual pocket location or to the order of thermometer use. CONCLUSION: The chemical dot thermometer is useful and reliable for measuring body temperature of orally intubated patients. When measurements of body temperature have important consequences for decisions about treatment, clinicians should use an electronic thermometer to confirm measurements made with a chemical dot thermometer.     

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。     

Management of fever in children: Summary of the Italian pediatric society guidelines

Objective: This article summarizes the Italian Pediatric Society guideline on the management of the signs and symptoms of fever in children, prepared as part of the National Guideline Program (NGLP).Methods: Relevant publications in English and Italian were identified through searches of MEDLINE and the Cochrane Database of Systematic Reviews from their inception through December 31, 2007. Based on the consensus of a multidisciplinary expert panel, the strength of the recommendations was categorized into 5 grades (A–E) according to NGLP methodology.Summary: In the health care setting, axillary measurement of body temperature using a digital thermometer is recommended in children aged <4 weeks; for children aged ≥4 weeks, axillary measurement using a digital thermometer or tympanic measurement using an infrared thermometer is recommended. When body temperature is measured at home by parents or care-givers, axillary measurement using a digital thermometer is recommended for all children. Children who are afebrile when seen by the clinician but are reported to have had fever by their caregivers should be considered febrile. In special circumstances, high fever may be a predictive factor for severe bacterial infection. Use of physical methods of reducing fever is discouraged, except in the case of hyperthermia. Use of antipyretics—paracetamol (acetaminophen) or ibuprofen—is recommended only when fever is associated with discomfort. Combined or alternating use of antipyretics is discouraged. The dose of antipyretic should be based on the child's weight rather than age. Whenever possible, oral administration of paracetamol is preferable to rectal administration. Use of ibuprofen is not recommended in febrile children with chickenpox or dehydration. Use of ibuprofen or paracetamol is not contraindicated in febrile children with asthma. There is insufficient evidence to form any recommendations concerning fever in children with other chronic conditions, but caution is advised in cases of severe hepatic/renal failure or severe malnutrition. Newborns with fever should always be hospitalized because of the elevated risk of severe disease; paracetamol may be used, with the dose adjusted to gestational age. Use of paracetamol or ibuprofen is not effective in preventing febrile convulsion or the adverse effects of vaccines.     

Accuracy of tympanic temperature readings in children under 6 years of age.

PURPOSE: Infrared tympanic thermometry (ITT) is increasingly used as a convenient, noninvasive assessment method for febrile children. However, the accuracy of ITT for children has been questioned, particularly in relation to specificity and sensitivity. This study was designed to (a) determine the correlation and extent of agreement between rectal temperature (RT) readings obtained by electronic thermometer and ear-based temperature readings obtained by ITT, and (b) determine the accuracy of detecting fever in children under 6 years of age. METHODS: This correlational study used a sample of 241 paired ear and rectal temperatures obtained in the emergency department (ED) of a 920-bed regional hospital. All children under the age of 6 years who routinely received a rectal temperature measurement were eligible to participate. According to the ED protocol, rectal temperatures were obtained on all patients less than 3 years or patients 3-6 years that presented with a complaint of fever. For the study, tympanic measurements were also taken. RESULTS: Correlation between rectal and tympanic temperature readings was statistically significant (r = 0.84, p < .001). The mean difference between rectal and tympanic temperatures was -0.60 degrees C. Threshold-adjusted accuracy in screening for fever was determined by sensitivity (80%), specificity (85%), positive predictive value (87%), and negative predictive value (85%). CONCLUSIONS: Sensitivity, specificity, positive predictive value, and negative predictive value are unacceptably low and the number of children with fever who would be missed by screening with a tympanic thermometer is unacceptable. Findings of this study do not support the use of tympanic thermometers to detect fever in children under 6 years of age.     

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.     

Evaluation of tympanic membrane thermometer for use with pediatric patients

To determine if a tympanic membrane thermometer is of benefit on a pediatric unit. Temperature readings using a tympanic membrane thermometer and an electronic thermometer were compared for 295 paired observations. The electronic temperature readings were done by rectal (n = 32), oral (n = 65), and axillary (n = 198) routes. Differences in tympanic and electronic readings were compared by paired t-tests, and the readings were also correlated. The nursing time in seconds was also compared between electronic and tympanic measurements. Parents and nurses rated their opinion of each type of measurement on a 0-5 Likert scale. Nurses rated the patient's response using the same scale. Results indicate that temperature readings differ by an average of .2- .5 degree between tympanic and electronic thermometers. Correlations are statistically significant but of low-to-moderate strength. Parents and nurses did not rate the types of instruments differently. The nurses rated the electronic axillary method as being more acceptable to toddlers. The tympanic membrane measurement took an average of 30-38 seconds less time to take. Tympanic membrane thermometry saves nursing time. Although the correlations were not strong between electronic and tympanic membrane measurements, the tympanic reading was closer to the electronic rectal reading than to axillary or oral readings.     

ICU患者体温测量方法现状分析

目的分析重症监护病房(intensive care unit,ICU)体温监测现状,为进一步探讨危重患者最佳体温测量方法提供参考。方法 2013年1月,便利抽样法选取北京、上海、成都、乌鲁木齐等地5所三级甲等医院的35个ICU为研究对象,实地调查ICU监测患者体温所采用的工具、测量部位及方法等。结果 35个ICU中,用水银体温计测量腋窝温度的使用率为91.43%;用监护仪配备的体温监测导线持续监测直肠内温度的使用率为2.86%;用红外线温度扫描仪分次测量额温的使用率为2.86%。结论目前三级甲等医院ICU多以水银体温计间歇测量腋窝温度作为体温测量的主要方法,应尽快找到更好的体温测量工具和部位,并实现持续监测。     

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.     

Temperature measurement in critically ill adults: a comparison of tympanic and oral methods.

BACKGROUND: Despite increasing use of tympanic thermometers in critically ill patients who do not have a pulmonary artery catheter in place, variations in measurements obtained with the thermometers are still a problem. OBJECTIVE: To compare the range of variability between tympanic and oral electronic thermometers. METHODS: Subjects were a convenience sample of 72 patients admitted to a 24-bed adult medical-surgical intensive care unit. For each patient, temperatures were measured concurrently (within a 1-minute period) with an oral (Sure Temp 678) thermometer, a pulmonary artery catheter (Baxter VIP Swan-Ganz Catheter), and 2 tympanic (FirstTemp Genius II and ThermoScan Ear Pro-1) thermometers. Each subject was used up to 3 times for data collection. Measurements obtained with the oral and tympanic thermometers were compared with those obtained with the pulmonary artery catheter. Nonparametric analysis of data was used. RESULTS: The magnitude of error for the ThermoScan tympanic thermometer differed significantly from that of the Genius II tympanic thermometer and the SureTemp oral thermometer (P < .001). Application of the Bland and Altman method to frame the data on the basis of an accuracy tolerance zone of +/-0.5 degrees C indicated variability with both the oral and tympanic methods. The overall degree of variability was lower for the oral thermometer. CONCLUSIONS: Oral thermometers provide less variable measurements than do tympanic thermometers. Use of oral thermometry is recommended as the best practice method for temperature evaluation in critical care patients when measurement of core temperature via a pulmonary artery catheter is not possible.     

Temperature measurement in intensive care patients: comparison of urinary bladder,oesophageal, rectal,axillary, and inguinal methods versus pulmonary artery core method

OBJECTIVE: Comparisons of urinary bladder, oesophageal, rectal, axillary, and inguinal temperatures versus pulmonary artery temperature. DESIGN: Prospective cohort study. SETTING: Intensive Care Unit of a University-Hospital. PATIENTS: Forty-two intensive care patients requiring a pulmonary artery catheter (PAC). INTERVENTION: Patients requiring PAC and without oesophageal, urinary bladder, and/or rectal disease or recent surgery were included in the study. Temperature was simultaneously monitored with PAC, urinary, oesophageal, and rectal electronic thermometers and with axillary and inguinal gallium-in-glass thermometers. Comparisons used a Bland and Altman method. MEASUREMENTS AND MAIN RESULTS: The pulmonary arterial temperature ranged from 33.7 degrees C to 40.2 degrees C. Urinary bladder temperature was assessed in the last 22 patients. A total of 529 temperature measurement comparisons were carried out (252 comparisons of esophageal, rectal, inguinal, axillary, and pulmonary artery temperature measurements in the first 20 patients, and 277 comparisons with overall methods in the last patients). Nine to 18 temperature measurement comparisons were carried out per patient (median = 13). The mean differences between pulmonary artery temperatures and those of the different methods studied were: oesophageal (0.11+/-0.30 degrees C), rectal (-0.07+/-0.40 degrees C), axillary (0.27+/-0.45 degrees C), inguinal (0.17+/-0.48 degrees C), urinary bladder (-0.21+/-0.20 degrees C). CONCLUSION: In critically ill patients, urinary bladder and oesophageal electronic thermometers are more reliable than the electronic rectal thermometer which is better than inguinal and axillary gallium-in-glass thermometers to measure core temperature.     

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.     

Are infrared and thermistor thermometers interchangeable for measuring localized skin temperature?

Localized skin temperature must be measured by accurate and reliable thermometers to effectively evaluate treatment outcomes, monitor changes, and predict potential complications. This study compared localized skin temperature measurements with a contact thermistor thermometer used as a reference standard and a noncontact infrared (IR) skin thermometer to determine their interchangeability with calculated Bland-Altman limits of agreement. Fifty-five adults ages 50 to 89 participated in the study in which data were collected in a climate-controlled room over 3 measurement periods, 1 week apart. The thermistor and IR thermometers were interchangeable with a limit of agreement of +/- 1.5 degrees C. This limit of agreement is acceptable as a reference standard for IR thermometers to measure localized skin temperature in clinical settings.     

Accuracy of Chemical Dot Thermometers in Critically Adults and Young Children

Chemical dot thermometers are used widely, but their clinical accuracy is not well documented. Temperature measurements with chemical dot and electronic thermometers were compared at the oral site in 27 adults and the axillary site in 44 adults and 34 young children in critical care units. In adults, mean readings with chemical dot thermometers were lower by -0.4°C orally, but higher by 0.4°C in the axilla. Axillary readings in children did not differ significantly with the two methods, although individual differences of ±0.4°C or more were common. Chemical dot thermometers provided rough temperature estimates, performing differently at the oral and axillary sites and in the two age groups.     

Comparison of the oral thermometer versus the tympanic thermometer.

After the use of tympanic thermometers replaced the use of oral thermometers at the Veterans Affairs Medical Center in Memphis, the nursing staff initiated a comparison study of the two instruments, monitoring 160 temperature readings. Current studies demonstrate that tympanic thermometers give presumably higher temperature readings than do oral thermometers. The study question asked was: Is there a clinically statistical difference between the measures of the two instruments? A statistically significant difference was found between the readings of the two instruments. Despite published results that infrared thermometers provide readings closer to core temperature than oral thermometers, the oral thermometer registered higher in 69% of the subjects. It may be premature to conclude that the oral thermometer is not as accurate as the tympanic thermometer. Removal of this proven oral system may need to be evaluated, and further comparison studies should be conducted before the tympanic thermometer is unconditionally embraced as the more accurate of the two.     

Diagnosis and treatment of pediatric fever by caretakers

Assessment of pediatric temperature is a multistep task involving both manipulative and cognitive skills. Emergency Physicians typically assume that parents possess these skills, but this assumption has never been fully tested. A prospective survey was conducted of caretakers of children < or = 36 months of age presenting to an inner city emergency department or pediatric clinic. Participants were asked to read a Fahrenheit scale mercury thermometer and to demonstrate use of that thermometer to "take" the temperature of an infant doll. They were then asked what temperature constituted a "fever" and what temperature would require antipyretic therapy. Caretakers were also asked how they would treat a fever in the child they had brought for treatment. Proportions of correct responses were tabulated and also compared by age and level of education of caretaker. Eighty-two of 92 caretakers (89.1%) possessed working thermometers in their homes. Thirty-six subjects (39.1%) were able to measure temperature appropriately using the mercury thermometer, 52 (56.5%) were able to read the mercury thermometer correctly, and 28 (30.4%) could both measure and read correctly. Sixty-seven subjects (72.8%) described correct treatment of fever. Overall, 27 subjects (29.3%) could measure, read, and treat fever appropriately. There was no statistically significant difference in age or percentage of high school graduates between caretakers who could successfully measure, read and treat and those who could not. In this inner city patient population, caretakers of any pediatric patient whose discharge instructions contain a reference to patient temperature should receive a brief refresher along with written instructions on temperature measurement and treatment.