Temperature References ====================== Stewart JV Webster D Re-evaluation of the tympanic thermometer in the emergency department [see comments] In: Ann Emerg Med (1992 Feb) 21(2):158-61 STUDY OBJECTIVE: A study was undertaken to re-evaluate tympanic temperatures using a commonly used portable infrared tympanic thermometer. DESIGN: Temperatures were recorded sequentially at two body sites using an electronic digital thermometer and an infrared tympanic thermometer. The tympanic thermometer was set to the core equivalency setting. SETTING: The emergency department of a Level 2 trauma center. TYPE OF PARTICIPANTS: Seventy-nine pediatric patients presenting to the ED. MEASUREMENTS AND MAIN RESULTS: Mean temperatures in the tympanic and rectal temperature groups were 38.5 +/- 1.08 C and 38.8 +/- 1.02 C, respectively (P greater than .05). The overall correlation of rectal and tympanic temperatures was 0.93 (P much less than .001). Stratifying the data by age resulted in a weakened correlation for patients 3 months of age and younger. For all strata, the sensitivity, specificity, positive predictive value, and negative predictive value of the tympanic thermometer for predicting fever were 96.6%, 100%, 100%, and 90.1%, respectively; for patients more than 3 months of age, the values were 100% in all categories. CONCLUSION: Our findings indicate that the First Temp infrared tympanic thermometer accurately detected fever in a pediatric population more than 3 months old. Results were inconclusive in patients less than 3 months old. Muma BK Treloar DJ Wurmlinger K Peterson E Vitae A Comparison of rectal, axillary, and tympanic membrane temperatures in infants and young children [see comments] In: Ann Emerg Med (1991 Jan) 20(1):41-4 STUDY OBJECTIVE: To evaluate the reliability of a tympanic membrane thermometer in detecting fever in young children presenting to the emergency department. SETTING: Pediatric emergency department in an urban teaching hospital, DESIGN/MEASUREMENT/PARTICIPANTS: Temperature measurements were obtained sequentially at three body sites in children less than 3 years old presenting to the pediatric ED. Axillary and rectal temperatures were obtained with an electronic thermistor probe (Diatek 500), and tympanic membrane temperatures were obtained with a noncontact, infrared sensing device (First TEMP). Patients were stratified by age, ear canal patency, presence of otitis media, and rectal temperature. RESULTS: Of 224 patients enrolled, 87 (39%) were febrile. Overall correlation of axillary and tympanic membrane measurements to rectal for all strata was .75 (P = .001) and .81 (P = .001), respectively. Sensitivity in detecting fever for axillary and tympanic membrane sites was .48 and .55, respectively. Otitis media and ear patency did not influence correlation of tympanic membrane measurements. Low tympanic membrane temperature sensitivity may be a result of probe configuration. CONCLUSION: Tympanic membrane and axillary temperatures should be viewed with caution in children less than 3 years old as neither can detect fever reliably. Hooker EA Use of tympanic thermometers to screen for fever in patients in a pediatric emergency department [see comments] In: South Med J (1993 Aug) 86(8):855-8 The use of tympanic thermometers has markedly increased over the past few years. While some authors have shown high correlation between rectal and tympanic readings, others have found low correlation. After noticing a failure of the tympanic thermometer to detect fever in obviously febrile pediatric patients, we prospectively evaluated its use in our emergency department. All patients less than 6 years of age who were brought in for care over a 2-week period were eligible for entry into the study. Nurses were trained in the proper use of the instruments before the study began. We used a calibrated tympanic thermometer (First Temp 2000A) and an electronic thermometer (IVAC 2080A). In all children the tympanic temperature was measured first, immediately followed by measurement of the rectal temperature. The 39 children entered into the study ranged in age from 2 to 71 months (mean of 27 months). Rectal temperature ranged from 97.8 degrees to 105.2 degrees F. The correlation between rectal and tympanic was low (r = .830) and was worse in patients with fever (r = .612). The mean difference was 0.8 degrees F, but was as high as 3.4 degrees F. The tympanic thermometer failed to identify five of the 15 febrile patients (T > or = 100.5 degrees F) in our study. We therefore conclude that the tympanic thermometer is not sensitive enough to be used to screen for fever in pediatric patients. Doezema D Lunt M Tandberg D Cerumen occlusion lowers infrared tympanic membrane temperature measurement. In: Acad Emerg Med (1995 Jan) 2(1):17-9 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 ages 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 of 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 degrees C lower than that of the opposite ear canal (p = 0.0001, 95% CI 0.16- 0.45 degrees C). CONCLUSION: Cerumen occlusion of the ear canal causes underestimation of body temperature measure by infrared tympanic membrane thermometry. Kelly B Alexander D Effect of otitis media on infrared tympanic thermometry. In: Clin Pediatr (Phila) (1991 Apr) 30(4 Suppl):46-8; discussion 49 This study was designed to determine if temperature readings using a new tympanic thermometer are affected by otitis media. These readings were also compared to a rectal or oral temperature. Eighty-four children with unilateral suppurative or non-suppurative otitis media diagnosed clinically by their pediatricians were enrolled in the study. Temperatures were measured in both ears using the Thermoscan PRO-1 Instant Thermometer and rectally or orally by a glass or electronic predictive thermometer. For 67 children with unilateral suppurative otitis media the mean temperature in infected ears was 0.38 degrees Fahrenheit higher than in uninfected ears (p = .005). Neither temperatures measured in affected nor those from unaffected ears differed significantly from oral or rectal control readings. For 17 children with unilateral non-suppurative otitis media there was no statistically significant difference between temperatures in affected and unaffected ears or between the temperatures in either ear and the oral or rectal control. Our data show that temperatures taken in ears with suppurative otitis media are slightly higher than those in normal ears. This difference is of minimal clinical significance and does not affect the accuracy when compared to oral or rectal control readings. Terndrup TE Rajk J Impact of operator technique and device on infrared emission detection tympanic thermometry. In: J Emerg Med (1992 Nov-Dec) 10(6):683-7 Preliminary data on the use of infrared emission detection (IRED) tympanic thermometers suggest that operator technique may be important in IRED readings. No systematic investigation of specific technique and available IRED devices has previously been performed. In a prospective, blinded trial, 40 healthy adult subjects using six IRED thermometers with two techniques were examined in random sequence. Differences between IRED tympanic, oral, and rectal temperatures were compared using ANOVA. Significant differences were observed between all temperatures, the IRED devices, and the method of probe insertion. Differences between oral or rectal temperatures and IRED tympanic readings were reduced by an ear tug (as for routine otoscopy) for all but one device. An "ear tug" results in increased IRED readings that may improve accuracy of tympanic thermometers using IRED. Milewski A Ferguson KL Terndrup TE Comparison of pulmonary artery, rectal, and tympanic membrane temperatures in adult intensive care unit patients. In: Clin Pediatr (Phila) (1991 Apr) 30(4 Suppl):13-6; discussion 34-5. Tympanic thermometry using infrared thermography technology offers a noninvasive, rapid temperature measurement tool which may be useful for selected intensive care unit (ICU) patients. Multiple comparisons of pulmonary artery catheter (PAC), rectal (R), and tympanic membrane (TM) temperatures were performed in nine adult ICU patients using PAC temperatures as the gold standard. The correlation between R (r = 0.93) and PAC was significantly better than TM (r = 0.74) temperatures. However, PAC (37.2 +/- 0.06 degrees C; mean +/- SEM) and TM (37.1 +/- 0.08 degrees C) temperatures were not significantly different, whereas R (37.6 +/- 0.07 degrees C) was significantly warmer than both (P less than .05). Differences between either R (+0.4 degrees C) or TM (-0.1 degrees C) and PAC temperatures were consistent over selected ranges between 35 degrees C and 40 degrees C. The performance of TM and R was similar in the ability to predict PAC temperatures. Brennan DF Falk JL Rothrock SG Kerr RB Reliability of infrared tympanic thermometry in the detection of rectal fever in children [see comments] In: Ann Emerg Med (1995 Jan) 25(1):21-30 STUDY OBJECTIVE: Recently published clinical guidelines for the management of febrile children are based on studies that used rectal temperature data to stratify the risk of bacteremia and septic complications. Appropriate management decisions rely on accurate detection and categorization of fever. Accordingly, this study compared the newer infrared tympanic thermometry (ITT) to rectal thermometry in this regard. DESIGN: Prospective observational study. SETTING: Urban teaching hospital ED with annual census of 60,000. PARTICIPANTS: Consecutive children 6 months to 6 years old who had rectal temperatures measured. INTERVENTIONS: Triage nurses recorded rectal temperatures and bilateral ITT temperatures. Temperatures were correlated by Pearson correlation coefficients and compared using paired t tests with significance set at P < .01. Children were categorized by degree of fever using rectal temperature (afebrile, less than 100.4 degrees F; low fever, 100.4 to 102.9 degrees F; and high fever, more than 102.9 degrees F), and the accuracy of ITT in detecting fever and high fever was determined. RESULTS: Three hundred seventy patients were enrolled in the study. The mean age was 18.4 +/- 11.3 months; boys comprised 56% of patients. The mean temperatures were rectal, 101.0 +/- 2.0 degrees F; right tympanic membrane, 100.4 +/- 1.9 degrees F; and left tympanic membrane, 100.3 +/- 1.9 degrees F. The tympanic membrane temperatures were significantly lower than rectal readings (P << .001 for both right and left versus rectal). Rectal temperatures showed good correlation with both right and left tympanic membrane temperatures (r = .83 and .85, respectively). ITT was 76% sensitive and 92% specific in detecting fever of 100.4 degrees F or more (positive predictive value, 0.92; negative predictive value, 0.76). In the detection of high fever, ITT was only 57% sensitive but 98% specific (positive predictive value, 0.90; negative predictive value, 0.90). Rectal and TM temperatures differed by at least 0.5 degree F in 70% of the patients, 1.0 degree F in 41%, 2.0 degrees F in 12%, and 3.0 degrees F in 3%. CONCLUSION: Despite the statistical correlation between ITT and rectal temperatures, the modalities may yield significantly different temperatures. The poor sensitivity of ITT in detecting fever and high fever may result in clinically important miscategorizations of individual patients. Current clinical management that is based on the presence and height of fever may be adversely affected if ITT is used.