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.     

Tympanic temperature measurements: are they reliable in the critically ill? A clinical study of measures of agreement

OBJECTIVE: Accurate measurement of temperature is vital in the intensive care setting. A prospective trial was performed to compare the accuracy of tympanic, urinary, and axillary temperatures with that of pulmonary artery (PA) core temperature measurements. DESIGN: A total of 110 patients were enrolled in a prospective observational cohort study. SETTING: Multidisciplinary intensive care unit of a university teaching hospital. PATIENTS: The cohort was (mean +/- sd) 65 +/- 16 yrs of age, Acute Physiology and Chronic Health Evaluation (APACHE) II score was 25 +/- 9, 58% of the patients were men, and 76% were mechanically ventilated. The accuracy of tympanic (averaged over both ears), axillary (averaged over both sides), and urinary temperatures was referenced (as mean difference, Delta degrees centigrade) to PA temperatures as standard in 6,703 recordings. Lin concordance correlation (pc) and Bland-Altman 95% limits of agreement (degrees centigrade) described the relationship between paired measurements. Regression analysis (linear mixed model) assessed covariate confounding with respect to temperature modes and reliability formulated as an intraclass correlation coefficient. MEASUREMENTS AND MAIN RESULTS: Concordance of PA temperatures with tympanic, urinary, and axillary was 0.77, 0.92, and 0.83, respectively. Compared with PA temperatures, Delta (limits of agreement) were 0.36 degrees C (-0.56 degrees C, 1.28 degrees C), -0.05 degrees C (-0.69 degrees C, 0.59 degrees C), and 0.30 degrees C (-0.42 degrees C, 1.01 degrees C) for tympanic, urinary, and axillary temperatures, respectively. Temperature measurement mode effect, estimated via regression analysis, was consistent with concordance and Delta (PA vs. urinary, p = .98). Patient age (p = .03), sedation score (p = .0001), and dialysis (p = .0001) had modest negative relations with temperature; quadratic relationships were identified with adrenaline and dobutamine. No interactions with particular temperature modes were identified (p > or = .12 for all comparisons) and no relationship was identified with either mean arterial pressure or APACHE II score (p > or = .64). The average temperature mode intraclass correlation coefficient for test-retest reliability was 0.72. CONCLUSION: Agreement of tympanic with pulmonary temperature was inferior to that of urinary temperature, which, on overall assessment, seemed more likely to reflect PA core temperature.     

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.     

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.     

Reliability of infrared ear thermometry in the prediction of rectal temperature in older inpatients

Aims and objectives. To assess the capability of infrared ear thermometry accurately to predict rectal temperature in older patients. Background. Infrared ear thermometry is now commonly used for predicting body temperature in older patients. However, ear thermometry has been insufficiently evaluated in geriatric patients. Design. Prospective, convenience sample, unblinded study. Methods. All patients (or their guardians) gave informed consent. Patients hospitalised in a geriatric unit underwent sequential ear and rectal temperatures measurements using two different models of infrared ear thermometers (ThermoScan and Genius) and a rectal probe, respectively. After a brief otoscopic examination, ear temperatures were measured twice at both ears with each thermometer, the highest of four measurements being retained for analysis. The rectal temperature was the reference standard. Results. Hundred patients (31 males), aged 81 (SD 7) years completed the study. The mean rectal temperature was 37·3 °C (SD 0·7) °C (range 36·3–40·7 °C). Eighteen patients were febrile (rectal temperature ≥ 37·8 °C). The mean bias between rectal and ear temperatures as measured with the ThermoScan was –0·20 °C (SD 0·32) °C and the 95% limits of agreement were –0·83 °C and 0·42 °C (95% CI, –0·88–0·48 °C). Using the Genius, the corresponding figures were –0·56 °C (SD 0·39) °C, –1·32 °C and 0·20 °C (95% CI, –1·39–0·27 °C). After correction for bias, the ThermoScan predicted the level of fever with a maximum error of 0·7 °C (mean error 0·3 °C). Using the Genius, the maximum error and the mean error were 1·6 °C and 0·4 °C, respectively. Conclusions. Infrared ear thermometry can predict rectal temperature in normothermic and in febrile inpatients with an acceptable level of accuracy. However, the predictive accuracy depends on both operator technique and quality of instrumentation. Relevance to clinical practice. Proper technique (measuring in both ears) and optimal instrumentation (model of ear thermometer) are essential for accuracy.     

Cerumen Occlusion Lowers Infrared Tympanic Membrane Temperature Measurement

Objective: To examine the effect that cerumen occlusion of the ear canal has on infrared tympanic membrane temperature measurement.
Methods: A prospective, randomized, single-blind human study was carried out in a university hospital observation unit. The subjects were a convenience sample of human volunteers aged 18 years or older who did not have cerumen occlusion or scarred tympanic membranes. A paraffin-coated human cerumen plug was placed in one randomly chosen ear, and after 20 minutes of equilibration the temperature in each ear was measured with an infrared thermometer. Analysis of the difference in mean temperature between the occluded and nonoccluded ears was by Student's paired t-test.
Results: Infrared tympanic membrane temperatures were measured in 43 subjects aged 21 to 58 years. The mean temperature of the occluded ear canal was 0.3°C lower than that of the opposite ear canal (p = 0.0001, 95% CI 0.16–0.45°C).
Conclusion: Cerumen occlusion of the ear canal causes underestimation of body temperature measured by infrared tympanic membrane thermometry.     

红外耳温计与玻璃体温计测量中的差异比较与研究

目的探讨红外耳温计与玻璃体温计在测量中的差异,研究耳温和腋温之间的关系。方法把110例病人,分为普通组30例,发热组80例,分别比较普通组、发热组耳温和腋温之间的差异。结果红外耳温计能反映正常体温变化,左右耳的平均温度误差较小,发热组病人的耳温和腋温的差异有高度显著性。结论红外耳式体温计测温快速、安全、测量准确、使用简单方便。     

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.     

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。     

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.     

A comparison of oral, rectal, and tympanic membrane-derived temperature changes after ingestion of liquids and smoking

Ambulatory patients frequently ingest liquids or smoke just before temperature measurement. The change in body temperature measurements over time following ingestion of ice water, hot water, and smoking were investigated. Twenty-two healthy, afebrile study subjects sequentially ingested temperature-controlled water and smoked a cigarette. Simultaneous oral and auditory canal temperatures were measured over 15 minutes following ingestion. Auditory canal temperatures were obtained with an infrared detection probe; we designated this process a tympanic membrane-derived (TMD) temperature. To determine the correlation between rectal and TMD temperatures, 100 patients had simultaneous measurements at both sites. Mean initial temperatures were rectal, 37.1 +/- 0.5 degrees C (mean +/- S.D.); oral, 36.4 +/- 0.4 degrees C; and TMD, 37.4 +/- 0.4 degrees C. Maximal mean oral temperature change was greatest at 1.5 minutes after hot, +0.9 +/- 0.1 degrees C, and cold, -1.2 +/- 0.2 degrees C, water. This change was statistically significant for seven minutes at the 95% confidence level (analysis of variance test with Dunnett's multiple range test for significance). There was no significant change in the TMD temperature with any ingestion. The Pearson correlation coefficient for 107 pairs of rectal and TMD temperatures, r = 0.90 (P less than .001), was excellent. It was concluded that hot and cold liquids significantly influence oral temperature measurement for seven to nine minutes following ingestion. TMD temperature is unaffected by liquid ingestion and may allow accurate measurement of body temperature. Further studies are needed to determine the accuracy of TMD temperature over a wide range of body temperature in diverse clinical settings.     

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。     

Accuracy of infrared ear thermometry in adult patients

Objective: To assess (1) the agreement between infrared ear thermometry and core reference temperature (in the pulmonary artery), (2) the agreement between measurements in the right and left ears, and (3) the screening validity of infrared tympanic thermometry in detecting rectal fever. Design: Temperatures were measured in both ears with an infrared thermometer, in one group of patients by simultaneous measurements with thermistors inserted in the pulmonary artery, esophagus, and rectum, and in the other group with a rectal glass-mercury thermometer. Setting: An intensive care unit and a department of internal medicine in a secondary care hospital. Patients and participants: Two samples: 16 adult patients admitted to the intensive care unit and 103 consecutive patients admitted to the department of medicine. Measurements: The major outcome measures were (a) the agreement between infrared ear thermometry and thermistor pulmonary artery temperature and (b) the sensitivity and specificity for detecting fever, using rectal measurement as reference. Results: Both rectal and esophageal thermistor measurements showed better agreement with the pulmonary artery reference temperature than single ear tympanic thermometry. The sensitivity and specificity of ear thermometry for detecting fever (≥38.0°C rectal reference) were 0.58 and 0.94, respectively. Double ear thermometry had a sensitivity of 0.61 and a specificity of 0.95, when using the mean value. Conclusions: Both rectal and esophageal thermistor measurements showed better agreement with pulmonary artery temperature than single ear thermometry. Using the mean of two ear measurements improves the agreement and screening validity for detecting fever by rectal temperature. If temperature measurements are critical, esophageal measurements achieve excellent agreement with pulmonary artery temperatures. Received: 15 November 1995 Accepted: 28 September 1996     

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.     

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.     

Accuracy and precision of noninvasive temperature measurement in adult intensive care patients.

BACKGROUND: Research on the accuracy and precision of noninvasive methods of measuring body temperature is equivocal. OBJECTIVES: To determine accuracy and precision of oral, ear-based, temporal artery, and axillary temperature measurements compared with pulmonary artery temperature. METHODS: Repeated-measures design conducted for 6 months. Sequential temperature measurements on the same side of the body were obtained within 1 minute, with measurements repeated 3 times at 20-minute intervals. Accuracy, precision, and confidence limits were analyzed. RESULTS: In 60 adults with cardiopulmonary disease and a pulmonary artery catheter, mean pulmonary artery temperature was 37.1 degrees C (SD 0.6 degrees C, range 35.3 degrees C-39.4 degrees C). Mean (SD) offset from pulmonary artery temperature (with the mean reflecting accuracy and SD reflecting precision) and confidence limits were 0.09 degrees C (0.43 degrees C) and -0.75 degrees C to 0.93 degrees C for oral measurements, -0.36 degrees C (0.56 degrees C) and -1.46 degrees C to 0.74 degrees C for ear measurements, -0.02 degrees C (0.47 degrees C) and -0.92 degrees C to 0.88 degrees C for temporal artery measurements, and 0.23 degrees C (0.44 degrees C) and -0.64 degrees C to 1.12 degrees C for axillary measurements. Percentage of pairs with differences greater than +/-0.5 degrees C was 19% for oral, 49% for ear, 20% for temporal artery, and 27% for axillary measurements. Intubation increased oral measurements compared with pulmonary artery temperatures (mean difference 0.3 degrees C, SD 0.3 degrees C, P = .001). CONCLUSIONS: Oral and temporal artery measurements were most accurate and precise. Axillary measurements underestimated pulmonary artery temperature. Ear measurements were least accurate and precise. Intubation affected the accuracy of oral measurements; diaphoresis and airflow across the face may affect temporal artery measurements.     

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).     

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.