Abstract
BackgroundA new generation of ear thermometers with preheated tips and several measurements points should allow a more precise temperature measurement. The aim of the study was to evaluate if the ear temperature measured by this ear thermometer can be used to screen for fever and whether the thermometer is in agreement with the rectal temperature and if age, use of hearing devices or time after admission influences the temperature measurements.MethodsOpen cross-sectional clinical single site study patients, > 18 years old, who were acutely admitted to the short stay unit at the ED. A sample size of 99 patient per subgroup was recruited as random convenience series. As ear thermometer Braun Thermoscan Pro 4000® and as rectal thermometer Omron Flex Temp Smart ® was used. For different cut off of temperature the AUC was calculated and Bland-Altman analysis for calculation of 95% limits of agreement with rectal temperature, with subgroup analysis concerning age, time span from admission time and use of hearing aid.ResultsAmong 599 patients the sensitivity to detect fever with an ear thermometer varied between 68 and 70% with AUC from 0.88–0.97. If the ear temperature was ≥37.5 oC, the sensitivity to detect patients with ≥38.0 oC rectally was 95% which raised to 100% for a rectal temperature of ≥38.3 oC. For the ear thermometer’s ability to determine the exact temperature the 95% limits of agreement were +/− 0.8 oC. with no influence from age, duration of hospital stay or hearing aids.ConclusionThe examined ear thermometer is able to detect fever, defined as ≥38 oC rectally in an adult ED population by using an ear cut-point of 37.5 oC, but not to measure the exact temperature. Used in this way around a fifth of the patients will still be in need of a rectal temperature measurement, but less than 5% with fever ≥38.0 oC will remain undetected and none with fever ≥38.3 oC. Age, admission time and use of hearing aid did not influence the temperature measurements.Trial registrationClinical Trials: ID NCT02977481, date 11/18/2016.
Highlights
A new generation of ear thermometers with preheated tips and several measurements points should allow a more precise temperature measurement
The mean time interval between the tympanic membrane (TM) temperature measurement and rectal temperature measurement was 0.7 min, 31% of the patients had taken an antipyretic medication on average 2.3 h before the temperature measurement, but none between the measurements; 8% used a hearing aid device
For all fever defining cut-points of rectal temperature, the sensitivity to detect a patient with fever using the ear thermometer varied between 68 and 70%, with negative predictive values (NPV) ranging from 90 to 99% and area under the curve (AUC) from 0.88–0.97
Summary
A new generation of ear thermometers with preheated tips and several measurements points should allow a more precise temperature measurement. The first study from a surgical ward recommended the use [3] while the second study from an emergency department (ED) found a cut-off of 37.5 °C feasible for screening purposes [7] and the third study, from an ED, did not recommend the new devices for clinical use [8]. These studies have not analyzed whether the results of the TM measurements were dependent on age, time after arrival from surroundings with a different temperature or use of hearing aids which are all factors that might influence the measurements
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