Tympanic Thermometer Research Articles

The Patient: A Novel Source of Error in Clinical Temperature Measurement Using Infrared Aural Thermometry

The vital signs are an important component of patient assessment. With respect to body temperature; there has been a move away from mercury-in-glass thermometers toward the relatively inexpensive, safer to use infrared tympanic, auricular, or ear thermometer. Although already in widespread use, the reliability of these devices has increasingly been called into question. Few studies, however, have considered that the problem might reside outside the device itself. To investigate the correlation between left ear temperature and right ear temperature using an infrared tympanic thermometer (ITT). A prospective, single-blind trail with randomized assignment of the first ear to be assessed. Welsh Institute of Chiropractic (WIOC), University of Glamorgan. One hundred and thirty two (132) asymptomatic subjects who were opportunistically sampled on entry into the WIOC. None of the subjects had any neurologic deficit, or any known underlying pathologic problems. All were students at the University of Glamorgan (age range, 18-48 years). A smaller sample of the same cohort was used on a separate occasion to compare ITTs from 2 different manufacturers using the same protocol. Measurement of ear (ear canal/tympanic) temperature bilaterally using an ITT. Bilateral asymmetry in ear canal temperature. Analysis consisted of nonparametric statistical tests, using Spearman's correlation for comparison and the Wilcoxon matched pairs test for differences. In 132 subjects who completed the main study, although a degree of correlation was found, the relationship did not extrapolate through zero. At temperatures more than 0.4 degrees C above or below 36.7 degrees C, there was a significant difference in temperature in the left compared with the right ear. Additionally, the left ear tended to register a lower temperature than the right ear at temperatures below 36.7 degrees C, whereas the left ear tended to read a higher temperature than the right ear above 36.7 degrees C. The authors suggest that clinicians consider measuring both ears, and take the greater of the readings to be a more accurate reflection of the patient's core temperature. The difference may perhaps even be related to the person's health. This change in methodology should increase the reliability of the measurement and go some way toward restoring confidence in the use of ITT devices.

Temperature measurement: comparison of non‐invasive methods used in adult critical care

To assess accuracy and reliability of two non-invasive methods, the chemical (Tempa.DOT) and tympanic thermometer (Genius First Temp M3000A), against the gold standard pulmonary artery catheter, and to determine the clinical significance of any temperature discrepancy using an expert panel. There is continued debate surrounding the use of tympanic thermometry in clinical practice. Prospective study. A total of 160 temperature sets were obtained from 25 adult intensive care patients over a 6-month period. About 75.2% (n = 115) of chemical and 50.9% (n = 78) of tympanic readings were within a +/-0.0-0.4 degrees 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 degrees C and -1.2-1.2 degrees C respectively. The chemical thermometer was associated with a mean temperature difference of 0.2 degrees C, which increased 0.4 degrees 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. 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. 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.

Comparing mercury‐in‐glass, tympanic and disposable thermometers in measuring body temperature in healthy young people

The aim of this study was to determine whether a disposable thermometer was at least as accurate as a tympanic thermometer when compared with a mercury-in-glass thermometer and to investigate the waiting periods of mercury-in-glass thermometers. Although different methods of temperature measurement have been widely studied and described during the last decade, comparison between readings obtained when measuring body temperature using disposable, mercury-in-glass and tympanic thermometers is little documented and there is confusion about the waiting periods of mercury-in-glass thermometers. This research was descriptive and comparative. Temperature measurements included three sequential readings using first a tympanic thermometer in the left ear, then a disposable thermometer in the left axillary area and finally a mercury-in-glass thermometer in the right axillary area. All the temperatures were measured on the Celsius (degrees C) scale. To identify the stabilization periods of the mercury-in-glass thermometers, the temperature measurement was repeated until the reading stabilized. F-tests were used to compare readings of the mean temperatures. It was found that body temperature readings measured by tympanic thermometer were higher than axillary mercury-in-glass thermometer by 0.12 degrees C, body temperature readings measured by tympanic thermometer were higher than axillary disposable thermometer readings by 0.65 degrees C and body temperature readings measured by axillary mercury-in-glass thermometer were higher by 0.53 degrees C than readings measured by axillary disposable thermometer. It was found that readings measured by mercury-in-glass thermometer stabilized in the eighth minute. When assessing body temperature it is important to take the type of thermometer into consideration. In addition, axillary mercury-in-glass thermometers must be kept in place a minimum of eight minutes.

Infrared ear thermometry in the critically ill patient: An alternative to axillary thermometry

Objective The purpose of this clinical study was to determine the accuracy of infrared tympanic membrane thermometry compared to axillary temperature (tempAx) for detecting body temperature reliably in critically ill patients in the daily practice. Materials and Methods Fifty adult patients admitted to a medical-surgical intensive care unit of an acute-care teaching hospital in Seville, Spain, during a 2-month period underwent prospective and simultaneous measurements of body temperature using a mercury-in-glass thermometer placed at the axilla of the dominant arm for at least 3 minutes and an infrared thermometer (ThermoScan 07, Braun Corporation, Kronberg, Germany) in both ears. Results A total of 429 simultaneous measurements of axillary temperature (tempAx) and tympanic temperature (tempTT) were made. The mean ± SD tempAx was 36.90°C ± 1.06°C and the mean tempTT was 36.94°C ± 0.97°C ( P = NS; 95% CI, −0.18 to 0.10), with a difference between tempTT and tempAx means of 0.04°C. There was a statistically significant correlation between tempAx and tempTT ( r = 0.813, P < .0005). When 20 extreme readings of both methods (<34.2°C and >39.8°C) were excluded, the mean tempAx was 36.91°C ± 0.86°C and the mean tempTT was 36.9°C ± 0.89°C ( P = NS; 95% CI, −0.05 to 0.06), with a difference of 0.01°C and a statistically significant correlation between both measurements ( r = 0.80, P < .0005). The sensitivity and specificity of tempTT for different thresholds were 74% and 85% for 37°C, 70% and 95% for 38°C, and 25% and 99.8% for 39°C, respectively. The negative predictive value for 39°C was 99%. Conclusions In adult intensive care unit patients, the infrared tympanic thermometer (ThermoScan 07) produced highly reliable measurements when compared to tempAx measured using a conventional mercury-in-glass thermometer. Both methods correlated positively and significantly.

Accuracy of parents in measuring body temperature with a tympanic thermometer

BackgroundIt is now common for parents to measure tympanic temperatures in children. The objective of this study was to assess the diagnostic accuracy of these measurements.MethodsParents and then nurses measured the temperature of 60 children with a tympanic thermometer designed for home use (home thermometer). The reference standard was a temperature measured by a nurse with a model of tympanic thermometer commonly used in hospitals (hospital thermometer). A difference of ≥ 0.5 °C was considered clinically significant. A fever was defined as a temperature ≥ 38.5 °C.ResultsThe mean absolute difference between the readings done by the parent and the nurse with the home thermometer was 0.44 ± 0.61 °C, and 33% of the readings differed by ≥ 0.5 °C. The mean absolute difference between the readings done by the parent with the home thermometer and the nurse with the hospital thermometer was 0.51 ± 0.63 °C, and 72 % of the readings differed by ≥ 0.5 °C. Using the home thermometer, parents detected fever with a sensitivity of 76% (95% CI 50–93%), a specificity of 95% (95% CI 84–99%), a positive predictive value of 87% (95% CI 60–98%), and a negative predictive value of 91% (95% CI 79–98 %). In comparing the readings the nurse obtained from the two different tympanic thermometers, the mean absolute difference was 0.24 ± 0.22 °C. Nurses detected fever with a sensitivity of 94% (95 % CI 71–100 %), a specificity of 88% (95% CI 75–96 %), a positive predictive value of 76% (95% CI 53–92%), and a negative predictive value of 97% (95%CI 87–100 %) using the home thermometer. The intraclass correlation coefficient for the three sets of readings was 0.80, and the consistency of readings was not affected by the body temperature.ConclusionsThe readings done by parents with a tympanic thermometer designed for home use differed a clinically significant amount from the reference standard (readings done by nurses with a model of tympanic thermometer commonly used in hospitals) the majority of the time, and parents failed to detect fever about one-quarter of the time. Tympanic readings reported by parents should be interpreted with great caution.

Effect of excessive environmental heat on core temperature in critically ill patients. An observational study during the 2003 European heat wave

The primary goal of this study was to investigate the relation between the core temperature of critically ill patients and hot ambient temperatures during a heat wave. The second goal was to evaluate the impact of such a heat wave on the number of microbiological tests ordered. During a heat wave, from August 3 to 22, 2003, we conducted an observational study in the surgical intensive care unit (ICU) of a French hospital that had no air-conditioning at the time. The core temperature of 18 critically ill patients and 36 health-care workers was measured with a non-contact, infrared tympanic membrane thermometer. The association between the core body temperature in infected and non-infected critically ill patients and the staff members, and the ambient temperature in the ICU was analysed using linear regression. The number of microbiological tests ordered was also recorded and compared with the same period in the previous year. The equation of the regression line for infected critically ill patients was: core temperature=33.5+0.16 x ambient temperature (R(2)=0.53; P<0.0001). The regression line was steeper than that for the non-infected patients (0.077; P<0.0001). The slopes of the regression lines for non-infected and control patients were similar (P=0.20). More blood cultures were carried out during the heat wave than at the same period during the year 2002 (4.80 blood cultures per 1000 patient-days vs 2.47 per 1000 patient-days; P=0.0006). During a sustained high ambient temperature, hyperthermia can occur in critically ill infected patients and to a lesser extent in non-infected patients and health-care workers. The number of blood cultures requested rises substantially, leading to increased costs. Installation of air-conditioning is therefore recommended.

Effect of Three Different Methods in Rewarming Hypothermic Postoperative Patients

Hypothermia refers to core body temperature less than 36C. It was reported that 60 to 80% of all postoperative patients suffered from hypothermia. Hypothermia has a profound effect on every body system and may result in life threatening problems if not recognised and treated promptly. The nurse has an important role in rewarming surgical patients immediately postoperatively. Many researchers found that there are different methods to warm surgical patients immediately postoperatively as radiation using infrared lamps, forced air warmer, and warmed blanket. Aim: Comparing between three different nursing methods in rewarming patients after major abdominal surgery. Method: The study was carried out in surgical wards and recovery rooms at Alexandria Main University Hospital. A convenient sample of 60 adult patients was selected and assigned randomly to one of three experimental warming methods. Group I was assigned to extra blanket, group II was assigned to radiation, and group III was assigned to forced air warmer. In postoperative period, all patients in the three different groups were assessed every 5 minutes for core body temperature using tympanic thermometer until return to baseline temperature. Results: The study revealed that the patients warmed with forced air warmer returned to baseline temperature in a shorter period than those who were warmed by the use of radiation or extra blanket. Statistically significant difference was found between the three groups. Conclusion: Rewarming is a priority in the immediate care of postoperative surgical patients because hypothermia may augment the risk of adverse outcome. Therefore, the importance of the use of forced air warmer, radiation using infrared heat lamps, or extra blanket should be emphasised in the postoperative period.

Focus on Analytical Instruments

Focus on Analytical Instruments

Need for a reliable system to measure body temperature

To the Editor:We read with interest the report by Ostrowsky et al,1.Ostrowsky B Ober J Wenzel R Edmond M The case of the cold thermometers.Am J Infect Control. 2003; 31: 57-59Abstract Full Text Full Text PDF PubMed Scopus (11) Google Scholar regarding the lack of precision of a temporal artery thermometer and their product evaluation process. A temporal artery thermometer, with a similar description to that trialed in the above referenced paper, was investigated at the University of Nebraska Medical Center.Similar to Ostrowsky and colleagues, we sought an easy, reliable system to measure body temperature. We, too, were hesitant to accept this device without peer-reviewed literature to support the marketing claims. Therefore, we conducted a trial in which 2 trained observers measured the body temperature of 34 ICU patients using a temporal artery thermometer, tympanic membrane thermometer, and oral thermometer. The patient's core temperature, as assessed by a pulmonary artery catheter, was regarded as the gold standard. Correlation between the temporal artery thermometer and the core body temperature was poor (r = 0.693) and did not support introduction of this device to our institution. Unfortunately, correlation between tympanic membrane thermometry and the core body temperature was only marginally better than the temporal artery thermometer (r = 0.721), and oral thermometry exhibited the least amount of agreement (r = 0.51).Our experience, and that of others,2.Giuliano K Scott S Elliot S Giuliano A Temperature measurement in critically ill orally intubated adults: a comparison of pulmonary artery core, tympanic, and oral methods.Crit Care Med. 1999; 27: 2188-2193Crossref PubMed Scopus (101) Google Scholar indicates a need for reliable means to assess body temperature. We concur with the conclusions of Ostrowsky and colleagues that peer-reviewed studies should be sought in evaluation of new technology and pilot studies should be conducted before introduction of a product if clear support for the product cannot be established in the literature. To the Editor: We read with interest the report by Ostrowsky et al,1.Ostrowsky B Ober J Wenzel R Edmond M The case of the cold thermometers.Am J Infect Control. 2003; 31: 57-59Abstract Full Text Full Text PDF PubMed Scopus (11) Google Scholar regarding the lack of precision of a temporal artery thermometer and their product evaluation process. A temporal artery thermometer, with a similar description to that trialed in the above referenced paper, was investigated at the University of Nebraska Medical Center. Similar to Ostrowsky and colleagues, we sought an easy, reliable system to measure body temperature. We, too, were hesitant to accept this device without peer-reviewed literature to support the marketing claims. Therefore, we conducted a trial in which 2 trained observers measured the body temperature of 34 ICU patients using a temporal artery thermometer, tympanic membrane thermometer, and oral thermometer. The patient's core temperature, as assessed by a pulmonary artery catheter, was regarded as the gold standard. Correlation between the temporal artery thermometer and the core body temperature was poor (r = 0.693) and did not support introduction of this device to our institution. Unfortunately, correlation between tympanic membrane thermometry and the core body temperature was only marginally better than the temporal artery thermometer (r = 0.721), and oral thermometry exhibited the least amount of agreement (r = 0.51). Our experience, and that of others,2.Giuliano K Scott S Elliot S Giuliano A Temperature measurement in critically ill orally intubated adults: a comparison of pulmonary artery core, tympanic, and oral methods.Crit Care Med. 1999; 27: 2188-2193Crossref PubMed Scopus (101) Google Scholar indicates a need for reliable means to assess body temperature. We concur with the conclusions of Ostrowsky and colleagues that peer-reviewed studies should be sought in evaluation of new technology and pilot studies should be conducted before introduction of a product if clear support for the product cannot be established in the literature.

Condicionantes otológicos en termometría timpánica con infrarrojos en niños

ObjectiveTo evaluate the influence of different otoscopic findings on body thermometry in children using an infra-red tympanic thermometer Patients and methodsBody temperature was measured on healthy right and left ear canals with Thermoscan systems. Moreover, it was determined on children with altered otoscopy, comparing to normal contralateral ear. To assess its diagnostic fiability, accuracy ratios were calculated in different temperatures ResultsTemperature measured bilaterally did not offer differences, and intra/interassay variation ratios were always less than 0,34%. Acute otitis externa increased tympanic thermometry a mean of 0,36 degrees C (p<0,001), and cerumen and previously radical surgery decreased a mean of 0,62 and 0,53 degrees C, respectively (p<0,001) ConclusionsThe conditions mentioned before modify body thermometry if measured by infrared tympanic thermometer. So, this system must be avoided in these circumstances. Otitis media, fluid in middle ear, tympanic perforation and ventilation tubes did not modify thermometric results

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.

Accuracy and feasibility of daily infrared tympanic membrane temperature measurements in the identification of fever in children

Background: Fever is an important physical sign in infectious diseases in childhood. Daily assessment of fever may be used to monitor the occurrence of infections for research purposes. The infrared tympanic membrane thermometer (ITT) seems ideal for measuring central body temperature. Its accuracy, however, is still debated, and the feasibility of daily temperature measurements with an ITT has not been described. Objective: To determine the accuracy and feasibility of daily infrared tympanic membrane temperature measurements at home. Methods: Tympanic membrane temperature was measured by the Braun Pro 3000, rectal temperature by the Omron MC 63. To establish the accuracy of the ITT, rectal and tympanic membrane temperature measurements were performed in 41 children, aged 2–10 years. To establish the feasibility of daily infrared tympanic temperature measurements at home, parents of 21 children performed daily measurements for 2 weeks. Results: With fever defined as a body temperature of ≥38.0 °C, sensitivity was 93.3%, specificity 92%, positive predictive value 87.5%, negative predictive value 95.8%, and the concordance rate 92.5%. Most of the parents found the instructions for the use of the ITT clear (93%) and the ITT easy to use (86%). During the test period of 2 weeks the technique of the tympanic membrane temperature measurements remained adequate in 93% of the parents. Conclusion: The tympanic membrane temperature measured by the Braun Pro 3000 accurately reflects rectal temperature, validly assesses the presence of fever in children, and is easy to use. The Braun ITT therefore is an adequate tool to assess fever and may be used both in a clinical setting and for research purposes.

Feasibility, accuracy and optimal location for oesophageal core temperature measurements using the ProSeal laryngeal mask airway drain tube.

We determined the feasibility, accuracy and optimal location of oesophageal core temperature measurements using the ProSeal laryngeal mask airway drain tube. Thirty normothermic anaesthetized ventilated adults (ASA 1 to 2, aged 18 to 80 years) were studied. Temperatures were recorded using a thermistor at six different locations (middle of drain tube and at 0 to 20 cm distal to the drain tube in 5 cm increments) and compared to nasopharyngeal (thermistor) and aural (infrared tympanic thermometer) reference core temperatures. The temperature probe was successfully inserted into the oesophagus in all patients at the first attempt. Oesophageal temperature increased with depth from 0 to 5 cm (35.2 v 35.9, P < 0.0001) and 5 to 10 cm (35.9 v 36.3, P < 0.01), but was unchanged from 10 to 15 cm (36.3 v 36.6) and 15 to 20 cm (36.6 v 36.7). Aural temperature was higher than nasopharyngeal temperature (36.8 v 36.0, P < 0.0001). Aural temperature was 0.89 to 1.59 degrees C higher than the oesophagus at 0 to 5 cm and 0.21 to 0.30 degree C higher than the oesophagus at 15 to 20 cm. Nasopharyngeal temperature was 0.06 to 0.76 degree C higher than the oesophagus at 0 to 5 cm and 0.62 to 0.84 degree C lower than the oesophagus at 15 to 20 cm. The lowest temperature was in the mid-point of the drain tube (34.7). We conclude that oesophageal core temperature measurement is feasible and accurate using the ProSeal laryngeal mask airway. The optimal location for the temperature probe is at 15 to 20 cm.

Should we replace the mercury in glass thermometer with the tympanic thermometer?

Objective: The tympanic thermometer is very popular and has been recently introduced to the hospitals of the Hospital Authority of Hong Kong. However, disagreement between the tympanic thermometer and the traditional mercury in glass thermometer is quite frequent. We attempt to explore the feasibility of using the tympanic thermometer in surgical patients and analyse if this thermometer is mature enough to replace the mercury in glass thermometer.Method: Fifty consecutive febrile and afebrile patients admitted into the surgical ward of a regional hospital were enrolled. Temperature was recorded by both thermometers. Mean differences and averages of the recordings were analysed.Results: A mean difference of 0.018 ± 0.54°C was found between the readings of the two thermometers in afebrile patients. Clinically, this translates to a difference of 0.54°C above or below the oral temperature. For febrile patients the mean difference was 0.24 ± 0.53°C. Thus, this translates to a difference of 0.67°C above or below the oral temperature.Conclusions: There was almost 1°C discrepancy between the tympanic thermometer and the mercury in glass thermometer. Whether this will affect clinical management is not known. Further clinical study is required. We do not recommend the replacement of the traditional mercury in glass thermometer by the tympanic thermometer.

Electrocardiographic manifestations of hypothermia

Hypothermia is generally defined as a core body temperature less than 35°C (95°F). Hypothermia is one of the most common environmental emergencies encountered by emergency physicians. Although the diagnosis will usually be evident after an initial check of vital signs, the diagnosis can sometimes be missed because of overreliance on normal or near-normal oral or tympanic thermometer readings. The classic and well-known electrocardiographic (ECG) manifestations of hypothermia include the presence of J (Osborn) waves, interval (PR, QRS, QT) prolongation, and atrial and ventricular dysrhythmias. There are also some less known (ECG) findings associated with hypothermia. For example, hypothermia can produce ECG signs that simulate those of acute myocardial ischemia or myocardial infarction. Hypothermia can also blunt the expected ECG findings associated with hyperkalemia. A thorough knowledge of these findings is important for prompt diagnosis and treatment of hypothermia. Six cases are presented that show these important ECG manifestations of hypothermia. (Am J Emerg Med 2002;20:314-326. Copyright 2002, Elsevier Science (USA). All rights reserved.)

Infrared tympanic thermometer can accurately measure the body temperature in children in an emergency room setting

Objective: The objective in this study was to compare the accuracy of the tympanic membrane infrared thermometer with the other conventional temperature measurement options. Methods: One hundred and ten randomly selected pediatric patients who admitted to our emergency room were included in the study. Each child underwent simultaneous temperature measurement via rectum, axilla, and external auditory canal. The rectal and axillary measurements were performed using conventional mercury in glass thermometers. The aural measurement was performed using the non-contact infrared thermometer (Braun ThermoScan IRT 1020, Germany). Results: On aural measurement, the results of both ears as well as the first, second and third measurements were similar ( P<0.01). The mean results of the axillary, rectal and tympanic temperature measurements were 37.46±1, 38.18±1, and 38.01±1.1, respectively. The mean axillary temperature was 0.72 °C lower than the mean rectal temperature, and 0.55 °C lower than the tympanic temperature. The difference between the mean tympanic and rectal temperatures was 0.17 °C. The results of measurements via rectum, axilla and ear were similar ( P<0.01). Conclusion: In conclusion, it is apparent that each of the temperature measurement options has some advantages and disadvantages. An optimal thermometer should have the following features; accurate temperature measurement; ease of application in a short while; safety and absence of potential risks; and tolerability by the patient. Since the aural infrared thermometer meets these criteria, its use in the routine clinical practice appears to be advantageous rather than or complementary to the conventional methods.

PISA. The effect of paracetamol (acetaminophen) and ibuprofen on body temperature in acute stroke: protocol for a phase II double-blind randomised placebo-controlled trial [ISRCTN98608690

During the first days after stroke, one to two fifths of the patients develop fever or subfebrile temperatures. Body temperature is a strong prognostic factor after stroke. Pharmacological reduction of temperature in patients with acute ischaemic stroke may improve their functional outcome. Previously, we studied the effect of high dose (6 g daily) and low dose (3 g daily) paracetamol (acetaminophen) in a randomised placebo-controlled trial of 75 patients with acute ischemic stroke. In the high-dose paracetamol group, mean body temperature at 12 and 24 hours after start of treatment was 0.4 degrees C lower than in the placebo group. The effect of ibuprofen, another potent antipyretic drug, on body-core temperature in normothermic patients has not been studied. The aim of the present trial is to study the effects of high-dose paracetamol and ibuprofen on body temperature in patients with acute ischaemic stroke, and to study the safety of these treatments. Seventy-five (3 x 25) patients with acute ischaemic stroke confined to the anterior circulation will be randomised to treatment with either: 400 mg ibuprofen, 1000 mg acetaminophen, or with placebo 6 times daily during 5 days. Body-temperatures will be measured with a rectal electronic thermometer at the start of treatment and after 24 hours. An infrared tympanic thermometer will be used to monitor body temperature at 2-hour intervals during the first 24 hours and at 12-hour intervals thereafter. The primary outcome measure will be rectal temperature at 24 hours after the start of treatment. The study results will be analysed on an intent-to-treat basis, but an on-treatment analysis will also be performed. No formal interim analysis will be carried out.

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.

Comparing tympanic membrane and pulmonary artery catheter temperatures

Studies comparing tympanic membrane thermometry with other thermometry methods have had conflicting results. Our hospital's nursing practice council sponsored this tympanic thermometry study in our cardiac surgical intensive care unit to assess the feasibility of increasing tympanic thermometer use in our hospital. Our results suggest clinically significant discrepancies between tympanic membrane and pulmonary artery catheter temperatures. These discrepancies preclude expanding tympanic thermometer use in our hospital.

The accuracy and reliability of the tympanic membrane thermometer. A literature review.

The accuracy and reliability of the tympanic membrane thermometer. A literature review.