Comparison of axillary and infrared tympanic membrane thermometry in a pediatric oncology outpatient setting

Agreement of Axillary and Auricular Temperature with Rectal Temperature in Systemically Healthy Dogs Undergoing Surgery

Obtaining a patient's temperature is an important part of a patient's physical examination. As human medicine transitions to noninvasive temperature measurements, so does veterinary medicine. Historically, temperature measurement has been obtained from rectal readings; however, alternative methods, such as axillary and auricular temperatures, are increasing in popularity. The purpose of the study was to compare these alternative techniques to the gold standard of rectal temperature. Temperatures were obtained three ways for each patient: rectal, axillary, and auricular. Results indicated a positive linear relationship between rectal and axillary temperatures (bivariate correlation coefficient [r] = 0.65, P < .001) and axillary and auricular temperatures (r = 0.55, P < .001). Agreement was strongest between rectal and auricular temperatures (r = 0.80, P < .001). The average discrepancy between axillary and rectal temperature was 1.2°C [2.1°F] with the highest difference being 4.0°C [7.3°F]. The average discrepancy between auricular and rectal temperature was 0.6°C [1.2°F] with the highest difference being 2.2°C [4.1°F]. Despite auricular temperatures having stronger agreement, Bland-Altman Limits of Agreement testing revealed that it was a poor predictor of rectal temperature. Based on these results, axillary and auricular temperatures should not be substituted for rectal temperature.

[Prospective study of tympanic temperature in patients undergoing haemopoietic transplant]

OBJECTIVE

During haemopoietic transplant, the patient may be affected by body temperature variations which may be associated with potential or real complications. In this clinical context and due unavoidable changes in values, we established as objectives; to check whether the reference values stated in the literature are adapted to our clinical reality, and to check the possible influence of mucositis in the determination of the tympanic temperature.

METHOD

A prospective descriptive study was performed on 776 cases in the Haemopoietic Transplant Unit of the Hospital Morales Meseguer, of Murcia, from the 13 March to the 15 September of 2002, in patients undergoing stem cells transplant. A 95% confidence level has been applied to the Chi(2) test in the statistical analysis.

RESULTS

The mean tympanic temperature obtained in the right ear was 37.4 degrees C, whereas the axillary mean was 36.54 degrees C. Grade II mucositis was found to be the main associated variable.

CONCLUSIONS

Some authors suggest that the tympanic temperature, despite the speed, reliability and lack of impact on the environment, is subject to many uncertainties that can lead to diagnostic errors and subsequent clinical decision. In our study, the reference values have differed from those previously obtained due to, among other things, them being values associated to healthy people, whereas in our case, the determinations were made in convalescents with mucositis. Therefore, given that the clinical condition affects the reliability of the tympanic readings, this method is not applicable in our clinical care.

Current practice and knowledge of nurses regarding patient temperature measurement

BACKGROUND

The measurement of patient temperature by nursing staff is a common activity. In recent years this area of practice has been largely under-investigated despite the introduction of new technologies into clinical practice, such as infrared tympanic thermometry (IRTT).

STUDY AIM

To investigate current practice in clinical temperature measurement in general, and the use of IRTT in particular by nursing staff.

SAMPLE AND METHODS

139 nursing staff from a general hospital in the UK were surveyed via a self-administered questionnaire.

MAIN FINDINGS AND CONCLUSIONS

The group most involved in temperature measurement was characterized as nursing auxiliary grades with the fewest years of experience. IRTT was the most frequently-used method for measuring patient temperatures, with high perceived accuracy, reliability, ease of use and acceptability to patients. A poor level of understanding and training in the use of IRTT was revealed across all clinical grades. Recommendations for future investigations are made.

Comparison of temporal artery thermometer to standard temperature measurements in pediatric intensive care unit patients

OBJECTIVES

To determine the accuracy of noninvasive infrared temporal artery thermometry compared with rectal, axillary, and pulmonary artery catheter measurements in pediatric intensive care patients, and to determine whether temporal artery temperatures are affected by circulatory shock or by vasopressor use. We hypothesized that temporal artery temperatures do not differ from axillary and rectal temperatures in critically ill children, but temporal artery accuracy is decreased by shock or vasopressor use.

DESIGN

Observational study, unblinded.

SETTING

Pediatric intensive care unit of a quarternary referral children's hospital.

PATIENTS

Seventy-five temperature comparison pairs were obtained in 44 pediatric intensive care unit patients.

INTERVENTIONS

Temperature measurements were made using a temporal artery thermometer with simultaneously obtained rectal, axillary, and, when available, pulmonary artery catheter measurements.

MEASUREMENTS AND MAIN RESULTS

Mean bias was calculated between comparison pairs using each temperature method. Bland-Altman analysis demonstrated wide variability between methods. No significant differences in mean bias were seen between method pairs for all temperatures, but bias was significantly less in pulmonary artery catheter-rectal pairs compared with other method pairs. In febrile (> 38 degrees C) patients, bias in rectal-temporal artery and rectal-axillary was significantly greater than in temporal artery-axillary pairs (p < .001). Mean bias in pulmonary artery catheter-rectal pairs was also significantly smaller than in other pairs for all patients (p = .008) and febrile patients (p = .049). Presence of shock or vasopressor use did not significantly increase bias in any comparison pair. Sensitivity and specificity of both temporal artery and axillary for diagnosing fever were similar and improved with fever definition at temperatures > 38.5 degrees C.

CONCLUSIONS

Temporal artery and axillary temperature measurements showed variability to rectal temperatures but had marked variability in febrile children. Neither was sufficiently accurate to recommend replacing rectal or other invasive methods. As temporal artery and axillary provide similar accuracy, temporal artery thermometers may serve as a suitable alternative for patients in whom invasive thermometry is contraindicated.

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.

Limited accuracy and reliability of infrared axillary and aural thermometers in a pediatric outpatient population

OBJECTIVE

To evaluate the accuracy and reliability of infrared axillary and aural thermometers in the outpatient setting.

STUDY DESIGN

A prospective observational study of infrared axillary, aural, and digital rectal temperature values from 198 children, aged 3 to 36 months (mean, 1.3 years).

RESULTS

Sensitivity and specificity of the axillary thermometer for rectal fever were 63.5% and 92.6%, respectively (diagnostic accuracy, 83.3%); those for the aural thermometer were 68.3% and 94.8%, respectively (diagnostic accuracy, 86.4%). For all patients, the mean biases of the axillary and aural temperatures were -0.33 degrees F and -0.24 degrees F, respectively. The biases of both thermometers' measurements were significantly correlated with rectal temperature (P <.02); thus, as rectal temperature increased, the accuracy of the compared axillary and aural temperature decreased. Underestimation of rectal temperature was greatest among febrile 1- to 3-year-old children (axillary bias, -1.20; aural bias, -0.36). Age was correlated with an axillary temperature bias (P <.01).

CONCLUSION

Axillary and aural infrared thermometers were comparable, albeit significantly different than rectal temperature measurements, particularly as the child's age and rectal temperature increased. These thermometers may be useful as noninvasive screening methods in outpatient settings for children who are at least 3 months old, but rectal values should be used for clinical accuracy.