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.     

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.     

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。     

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.     

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.     

Infrared tympanic thermometers are unreliable in low ambient temperatures

Study objective To assess the accuracy of infrared emission detection tympanic thermometers at ambient temperatures near and below their specified operating ambient temperature range. Methods In a pilot and subsequent study, two operators, using two brands of infrared emission detection thermometers in ambient temperatures ranging from 24.6°C to ?22.1°C measured tympanic temperatures of five healthy male volunteers. Each tympanic temperature measurement was taken twice by each operator, with both thermometers, in both ears of each subject. Results were compared with the subjects’ rectal temperatures taken simultaneously. Results A total of 240 tympanic temperature readings were made. In all ambient temperatures there was close agreement between operators and between left and right ears. With decreasing ambient temperatures there was an increasing and significant difference between rectal and tympanic temperatures. Tympanic temperatures were always lower than rectal readings. Both thermometers only gave warning displays of low ambient temperature when used in ambient temperatures well below their specified operating range. Only one brand continued to give readings at very low ambient temperatures and these were substantially inaccurate. Conclusions Infrared emission detection thermometers have limitations in low ambient temperatures. Operators should be aware of these limitations. Development of models of infrared emission detection devices with a wider operating ambient temperature range may be appropriate for use in the field.     

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.     

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.     

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。     

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.     

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.     

A multimethod approach to evaluate chemical dot thermometers for oral temperature measurement

Limited research has explored the accuracy of chemical dot thermometers for oral temperature measurement in adults. This study was undertaken to assess the agreement between oral temperatures taken with an electronic thermometer and single-use chemical dot thermometers in healthy women undergoing surgical delivery. During operative delivery, oral temperatures taken every 15 minutes with both the reference electronic thermometer (ETT) and a Tempa.DOT (TDT) chemical dot thermometer were compared. Data were analyzed using paired t tests, the Bland and Altman plot, and the concordance correlation coefficient. The total number of paired observations for the 62 subjects was 212. The mean difference between the two measurements was 0.35 +/- 0.32 degrees C (p < .0001, 95% CI 0.31, 0.40). Additional analysis indicated a serious undermeasurement by TDT of ETT temperatures. Data from multiple methods of analysis indicate that the Tempa.DOT chemical dot thermometer significantly undermeasures ETT and is not a reliable indicator of oral temperature.     

Use of infrared thermometry to measure lavage and intravenous fluid temperature

A study was conducted to determine the accuracy of tympanic thermometers for measuring the temperature of warmed fluids in fluid bags and in tubing at the delivery site (ie, beside the intravenous [IV] catheter). One-liter 0.9% saline bags were warmed in a microwave oven. A thermocouple electronic temperature probe was then used to measure the reference temperature. The probe was inserted into each bag and bathed in the fluid. Temperature changes were recorded simultaneously over a 20-minute period using the probe and a First Temp Tympanic Thermometer (Intelligent Medical Systems, Inc, Carlsbad, CA). The warmed fluid was then allowed to run through microdrip IV tubing. Temperature of the effluent was measured in the tubing using the tympanic thermometer externally and the probe internally at the same point. The two measures were compared using linear regression and Student's t tests. Overall, the correlation between the two probes was r = 0.99 for both the fluid bags and the IV tubing. The overall mean differences were small, 0.7°C and 1.2°C for the bags and tubing, respectively, but they were statistically different (P > .05). Data were analyzed in three temperature ranges: <36°C, 36°C to 41°C, and >41°C. Again, small differences were found on the order of 1°C. It was concluded that infrared thermometry is an accurate method for measuring the initial and delivery temperature of warmed fluids. Although tympanic thermometer measurements were statistically different from reference readings in certain temperature ranges, these differences were small and not clinically significant. Tympanic thermometers can measure the temperature of warmed fluid bags and lavage and IV effluent adjacent to the catheter site, ensuring that hypothermic patients receive fluid at therapeutic temperatures.     

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.     

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.     

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.     

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.     

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。