Tympanic Temperature Readings Research Articles

A Novel Non-Invasive Thermometer for Continuous Core Body Temperature: Comparison with Tympanic Temperature in an Acute Stroke Clinical Setting.

There is a growing research interest in wireless non-invasive solutions for core temperature estimation and their application in clinical settings. This study aimed to investigate the use of a novel wireless non-invasive heat flux-based thermometer in acute stroke patients admitted to a stroke unit and compare the measurements with the currently used infrared (IR) tympanic temperature readings. The study encompassed 30 acute ischemic stroke patients who underwent continuous measurement (Tcore) with the novel wearable non-invasive CORE device. Paired measurements of Tcore and tympanic temperature (Ttym) by using a standard IR-device were performed 3–5 times/day, yielding a total of 305 measurements. The predicted core temperatures (Tcore) were significantly correlated with Ttym (r = 0.89, p < 0.001). The comparison of the Tcore and Ttym measurements by Bland–Altman analysis showed a good agreement between them, with a low mean difference of 0.11 ± 0.34 °C, and no proportional bias was observed (B = −0.003, p = 0.923). The Tcore measurements correctly predicted the presence or absence of Ttym hyperthermia or fever in 94.1% and 97.4% of cases, respectively. Temperature monitoring with a novel wireless non-invasive heat flux-based thermometer could be a reliable alternative to the Ttym method for assessing core temperature in acute ischemic stroke patients.

Comparison of temperature readings using infrared thermometers at three different sites: tympanic, forehead and temporal

The aim of this study was to compare the body temperature measurements at tympanic, forehead and temporal sites using infrared thermometers. A total of 1576 consecutive visitors to Singapore General Hospital at two entry locations were included in this study. Pearson correlation and Bland–Altman mean difference between sites (95% confidence interval for limits of agreement) were calculated for the relationship between the three different sites of temperatures recorded (i.e. temporal, forehead and tympanic). Of all the visitors, 27 (1.7%) had fever. Moderate positive correlation was found between temporal and forehead temperature readings ( r=0.602, mean difference (temporal – forehead), (95% limits of agreement) = 0.1 (−0.8, 0.7)), and there was very weak positive correlation between tympanic and temporal temperature readings ( r=0.177, mean difference (temporal – tympanic), (95% limits of agreement) = −0.3 (−1.7, 1.1)). Sensitivity for temporal temperature readings (⩾37.5°C) to detect febrile visitors was 3.7%, specificity was 99.6%, positive predictive value was 14.3% and negative predictive value was 98.3%. Our results demonstrate that tympanic temperature readings should be used for fever screening instead of temporal or forehead readings.

Proof of concept for a syndromic surveillance system based on routine ambulance records in the South West of England, for the influenza season 2016/2017.

Introduction:The introduction of electronic patient records in the ambulance service provides new opportunities to monitor the population. Approximately 36% of patients presenting to English ambulance services are discharged at scene. Ambulance records are therefore an ideal data source for syndromic early event detection systems to monitor infectious disease in the pre-hospital population. It has been previously found that tympanic temperature records can be used to detect influenza outbreaks in emergency departments. This study aimed to determine whether routine tympanic temperature readings collected by ambulance crews can be used to detect seasonal influenza.Methods:Here we show that temperature readings do allow the detection of seasonal influenza before methods applied to conventional data sources. The counts of pyretic patients were used to calculate a sliding case ratio as a measurement to detect seasonal influenza outbreaks. This method does not rely on conventional thresholds and can be adapted to the data.Results:The data collected correlated with seasonal influenza. The 2016/2017 outbreak was detected up to nine weeks before other surveillance programmes. The results show that ambulance records can be a useful data source for biosurveillance systems.Conclusion:Temperature readings from routinely collected ambulance patient records can be used as a surveillance tool for febrile diseases.

04 Using electronic patient records collected by ambulance personnel to detect disease outbreaks

BackgroundThe introduction of electronic patient records in the ambulance service allows to use these to monitor the population. Most patients are discharged at scene therefore this data represents a new source for syndromic disease surveillance. The accessibility and extent of the records allows to apply early event detection (EED) systems to monitor the prehospital population. Here such a system is applied to tympanic temperature readings to detect seasonal influenza.MethodTympanic temperature readings, are recorded for all patients and were used to determine daily and weekly numbers of pyretic patients. A method adapted from Singh et al. (2016) based on case ratios (CR) was used to detect the start of the seasonal influenza outbreak. This method does not rely on thresholds, and was applied in a sliding manor as EED system.ResultsThe data represented annually 15.96% of the population, focused on the elderly. It matched the progress of seasonal influenza cases from sentinel surveillance programs. For the season 2016/17 an increase in cases was detected with an estimated specificity and sensitivity of 99.7% and 100%, up to 9 weeks before sentinel surveillance programs. Furthermore, an unanticipated outbreak of Escherichia coli was detected.ConclusionIt was shown, disease outbreaks can be monitored using prehospital tympanic temperature data. Thus, making the ambulance service an ideal source for syndromic surveillance. The method used was effective and can be easily deployed to monitor specific syndromes to distinguish between infectious agents. The method is easily adapted to sample rates and noisiness of the data to prevent false alarms.

Accuracy of Recorded Body Temperature of Critically Ill Patients Related to Measurement Site: A Prospective Observational Study

Accurate measurement of body temperature is an important indicator of the status of critically ill patients and is therefore essential. While axillary temperature is not considered accurate, it is still the conventional method of measurement in Asian intensive care units. There is uncertainty about the accuracy of thermometers for the critically ill. We compared the accuracy and precision of bladder, axillary and tympanic temperature measurements in critically ill patients. A total of 73 critically ill patients admitted to the intensive care unit of a teaching hospital were prospectively enrolled. Every four hours, we measured body temperature at three sites (bladder, axillary and tympanic). If the patient had received an indwelling pulmonary artery catheter, blood temperature was also recorded and this was compared with bladder, axillary and tympanic temperature readings. For all patients, axillary and tympanic temperature readings were compared with bladder temperature readings. Accuracy and precision were analysed using Bland-Altman analysis. When blood temperature data was available, the mean difference between blood and bladder temperature readings was small (0.02±0.21°C). Compared with bladder temperature, mean difference for axillary temperature was -0.33±0.55°C and for tympanic temperature it was -0.51±1.02°C. For critically ill patients, recorded axillary temperature was closer to bladder temperature than tympanic temperature.

Oral and Tympanic Membrane Temperatures are Inaccurate to Identify Fever in Emergency Department Adults

Introduction Identifying fever can influence management of the emergency department (ED) patient, including diagnostic testing, treatment, and disposition. We set out to determine how well oral and tympanic membrane (TM) temperatures compared with rectal measurements.MethodsA convenience sample of consecutively adult ED patients had oral, TM, and rectal temperatures performed within several minutes of each other. Descriptive statistics, Bland–Altman agreement matrices with 95% confidence interval (CI), and measures of test performance, including sensitivity, specificity, predictive values, and interval likelihood ratios were performed.ResultsA total of 457 patients were enrolled with an average age of 64 years (standard deviation: 19 years). Mean temperatures were: oral (98.3°F), TM (99.6°F), and rectal (99.4°F). The mean difference in rectal and oral temperatures was 1.1°F, although there was considerable lack of agreement between oral and rectal temperatures, with the oral temperature as much as 2.91°F lower or 0.74°F higher than the rectal measurement (95% CI). Although the difference in mean temperature between right TM and rectal temperature was only 0.22°F, the right TM was lower than rectal by up to 1.61°F or greater by up to 2.05°F (95% CI). Test performance varied as the positive predictive value of the oral temperature was 97% and for tympanic temperature was 55% (relative to a rectal temperature of 100.4°F or higher). Comparative findings differed even at temperatures considered in the normal range; among patients with an oral temperature of 98.0 to 98.9, 38% (25/65) were found to have a rectal temperature of 100.4 or higher, while among patients with a TM of 98.0 to 98.9, only 7% (10/134) were found to have a rectal temperature of 100.4 or higher.ConclusionThe oral and tympanic temperature readings are not equivalent to rectal thermometry readings. Oral thermometry frequently underestimates the temperature relative to rectal readings, and TM values can either under- or overestimate the rectal temperature. The clinician needs to be aware of the varying relationship between oral, TM, and rectal temperatures when interpreting readings.

Tympanic Membrane Versus Temporal Artery Temperatures of Adult Perianesthesia Patients

Reaching preoperative temperature stability is a critical discharge criterion afer anesthesia and surgery. Although numerous methods of measuring temperature exist, tympanic membrane (TM) thermometers have replaced oral thermometers in most perianesthesia units. With reliability of tympanic temperature readings being questioned in numerous reports and by many practitioners, the temporal artery (TA) thermometer has gained popularity among perianesthesia nurses for its noninvasive approach and ease of operation. A prospective study was undertaken to determine the ability of the TA thermometer to substitute for the TM thermometer in adult perianesthesia patients.

Take care with TYMPANIC temperature readings

Take care with TYMPANIC temperature readings

Non-contact infrared thermometry temperature measurement for screening fever in children

During the SARS epidemic, mass fever screening at border control points and public hospitals was done by measuring forehead temperature by non-contact infrared thermometry. However, its accuracy is not well documented. We evaluated the agreement of non-contact infrared forehead temperature (NIFT) measurement by comparing NIFT readings with tympanic temperatures taken in children (1 mth to 18 yrs) admitted to the general paediatric wards of Kwong Wah Hospital, Hong Kong. A total of 567 patients were recruited and 1000 pairs of readings were obtained. The incidence of fever, defined as tympanic temperature (in rectal model) >38 degrees C (100.4 degrees F), was 12.3%. The mean difference between NIFT and tympanic temperature was 2.34 degrees C (4.21 degrees F) and the 95% limit of agreement between NIFT and tympanic temperature was 0.26-4.42 degrees C (0.47-7.96 degrees F). NIFT was significantly lower than tympanic temperature readings. The optimal cut-off point of NIFT derived from the receiver-operator characteristics curve for fever definition was 35.1 degrees C (95.2 degrees F). The sensitivity, specificity, positive predictive value and negative predictive value of this cut-off point for fever screening were 89.4%, 75.4%, 33.7% and 98.1%, respectively. NIFT measurement has a reasonable accuracy in detecting tympanic fever in children. However, one should be aware of the high false-positive rate of fever screening using NIFT.

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.

A Comparative Study of Three Warming Interventions to Determine the Most Effective in Maintaining Perioperative Normothermia

Perioperative hypothermia poses a challenge because of its deleterious effects on patient recovery. The current practice of applying two cotton blankets on patients during surgery is thought to be less ideal than using reflective insulation or forced-air warming. We studied 300 patients who underwent unilateral total knee replacement and were randomized equally to three groups: (a) the two-cotton-blanket group, (b) the one-reflective-blanket with one-cotton-blanket group, and (c) the forced-air-warming with one-cotton-blanket group. Tympanic temperature readings were taken before surgery in the induction room, on arrival at the recovery room, and at 10-min intervals until discharge from the recovery room. On arrival at the recovery room, the forced-air-warming group had significantly higher temperatures (adjusted for sex, age, and patient's induction room temperature) of 0.577 degrees C +/- 0.079 degrees C (95% confidence interval [CI], 0.427-0.726; P < 0.001) and 0.510 degrees C +/- 0.08 degrees C (95% CI, 0.349-0.672; P < 0.001) more than the reflective-blanket and two-cot-ton-blanket groups, respectively. The forced-air-warming group took a significantly (P < 0.001) shorter time of 18.75 min (95% CI, 13.88-23.62) to achieve a temperature of 36.5 degrees C in the recovery room as compared with 41.78 min (95% CI, 36.86-46.58) and 36.43 min (95% CI, 31.23-41.62) for the reflective-blanket and two-cotton-blanket groups, respectively. The reflective technology was less effective than using two cotton blankets, and the forced-air warming was most efficient in maintaining perioperative normothermia. Perioperative hypothermia has deleterious effects on patient recovery. We found in patients having knee surgery that reflective technology was less effective than using two cotton blankets, whereas active surface warming with the forced-air method was most effective in maintaining normothermia.

ACCEPTABLE AGREEMENT BETWEEN TYMPANIC AND RECTAL TEMPERATURE IN ACUTE STROKE PATIENTS

SUMMARYMajor concerns remain about the reliability of tympanic thermometers. The aim of this study was to investigate the agreement between rectal and tympanic thermometry and compare this with the repeatability of each method in patients with acute stroke. Tympanic temperature readings were from 0.7°C below to 0.8°C above rectal readings. As to repeatability, we found second rectal readings to be between 0.3°C below and 0.4°C above first readings, and second tympanic readings to be between 0.4°C below and 0.5°C above first readings. The agreement between the two methods is acceptable in clinical practice. Tympanic thermometry is useful in serial measurements, whereas, for a single accurate measurement, rectal mercury thermometry remains the method of choice.

Infrared tympanic thermometers are unreliable in low ambient temperatures

AbstractStudy 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.

A comparison of tympanic thermometer readings to pulmonary artery catheter core temperature recordings

The purpose of this study was to determine the accuracy of FirstTemp (Intelligent Medical Systems, Carlsbad, CA) tympanic thermometer readings compared with core body temperatures obtained via pulmonary artery catheter (PAC). Five measurements were obtained on 19 cardiovascular surgery patients. Tympanic thermometer measurements tended to be higher than PAC measurements. However, most of the differences were not clinically significant. Differences found between right and left ear measurements were most likely due to poor measurement technique. When the correct technique is used, nurses can be confident that tympanic temperature readings are clinically accurate.

Determination of Thermoregulatory State in Full-Term Infants

A series of nine sets of axillary and tympanic (core) temperature readings were collected from each of 45 full-term infants during the first 4 hours after birth. The pattern of readings and the relationship between axillary and tympanic temperature readings were examined in each infant to determine whether the type of thermal state could be detected and categorized. The findings support the supposition that different thermal states are present and can be determined by the relationship between tympanic and axillary temperature readings. The ability to predict tympanic temperature decrease could not be predicted through examination of axillary-tympanic temperature patterns.