红外额式体温计在发热门诊中对于发热筛查的价值及最佳界值研究

目的 评价红外额式体温计在筛查发热患者中的价值,并找出其用来判断发热的最佳界值,为临床使用红外额式体温计提供依据。 方法 固定专人测量北京大学第三医院发热门诊2018年6月1日—8月30日就诊的1 176例患者体温,采用自身对照的方法,使用红外额式体温计与水银式体温计分别测量。 结果 1 176例患者中,男性529例(45%),女性647例(55%),平均年龄(36.91±16.46)岁。Bland-Altman结果显示额温腋温测量一致性较好。水银式体温计测量腋温为(38.31±0.67)℃,红外额式体温计测量额温为(37.30±0.77)℃,二者平均差值(1.01±0.64)℃(t=53.774,P<0.001)。体温正常组、低热组、中热组、高热组的腋温和额温差值分别为(0.25±0.55)、(0.83±0.50)、(1.08±0.66)、(1.33±0.70)℃,t值分别为2.180、35.721、36.760及25.710,均P<0.05。红外额式体温计测量体温的灵敏度为0.482,特异度为0.913。ROC曲线下面积AUC为0.73,P<0.001,95%CI为0.650~0.811。最大约登指数为0.477,所对应的界值为37.05℃。 结论 红外额式体温计测量体温与水银体温计所测得的腋温存在一定差异,前者比后者低。而且随着体温的升高,差异增大。红外额式体温计可在发热门诊中使用,由于临床使用红外额式体温计进行体温测定时读数只能到小数点后1位,但应以37.0℃作为初步判断患者是否发热的依据。 

Study on the value and optimal cut-off value of infrared forehead therm ometer for fever screening in the fever clinic

Objective To evaluate the value and the optimal cut-off value of infrared forehead thermometer for fever screening. Methods Body temperatures of 1 176 patients who visited the fever clinic from June 1 st to August 30 th 2018 were measured using both infrared forehead thermometer and mercury thermometer. Results Among 1 176 patients, 529(45%) were males and 647(55%) were females, with the mean age of 36.91±16.46 years old. Bland-Altman results showed that the consistency of frontal temperature and axillary temperature was relatively good. The average temperature measured by the mercury thermometer was(38.31±0.67)℃, while the average temperature measured by the infrared forehead thermometer was(37.30±0.77)℃. The mean difference was(1.01±0.64)℃. Paired t-test showed that t value was 53.774, P<0.001. The mean difference between the two types of temperatures for the normal temperature group, low fever group, moderate fever group and high fever group were(0.25±0.55),(0.83±0.50),(1.08±0.66) and(1.33±0.70)℃, respectively. The t values were 2.180, 35.721, 36.760 and 25.710, respectively, P<0.05. The sensitivity and specificity of using the infrared forehead thermometer to measure the body temperature were 0.482 and 0.913, respectively. The area under the ROC curve was 0.73, P<0.001, the 95% confidence interval was 0.650~0.811. The maximum value for the Youden index was 0.477, and the corresponding temperature was 37.05℃. Conclusion There is statistically significant difference between the body temperatures measured by the infrared forehead thermometer and the mercury thermometer, with the former lower than the latter. The higher the body temperature is, the more difference is. Since the temperature reading of infrared frontal thermometer can only be read to one decimal place in clinical practice, 37.0℃ should be used as the basis for preliminary determination of whether the patient has fever.