Darowski A, Najim Z, Weinberg J, Guz A
Department of Medicine for the Elderly, Edgware General Hospital, Middlesex.
Age Ageing. 1991 May;20(3):193-8. doi: 10.1093/ageing/20.3.193.
We studied 74 patients whose temperature was normal according to nurses' temperature charts and who were not on antibiotic treatment. The subjects were inpatients whose condition had deteriorated on the ward, or patients admitted the previous day in whom no diagnosis had been established. One simultaneous set of measurements was made of sublingual, rectal, axillary and proximal auditory canal temperatures. A fever was recorded in 63 of 74 patients (85%); 54 febrile patients had a raised rectal temperature, and 54 had a raised proximal auditory canal temperature; 60 patients were febrile at one or both of these sites. A further three patients had raised sublingual temperatures alone. All patients who were regarded as being definitely or probably infected were febrile at one or more sites. Eighty-one per cent of those considered to be possibly infected, and 71% of those with no clinical evidence of infection were also febrile. Rectal and proximal auditory canal temperatures can each detect fever in approximately 86% of febrile patients, sublingual temperature in 66%, and axillary temperature in 32%. Rectal temperature is clinically the most useful temperature measurement in elderly patients. We conclude that significant infections in patients in a warm environment result in a fever which often remains undetected when only sublingual temperature is measured.
我们研究了74例根据护士体温记录显示体温正常且未接受抗生素治疗的患者。研究对象为在病房病情恶化的住院患者，或前一天入院但尚未确诊的患者。同时对患者的舌下、直肠、腋窝及外耳道近端温度进行了测量。74例患者中有63例（85%）出现发热；54例发热患者直肠温度升高，54例外耳道近端温度升高；60例患者在上述一个或两个部位发热。另有3例患者仅舌下温度升高。所有被认为明确或可能感染的患者在一个或多个部位发热。被认为可能感染的患者中81%发热，无感染临床证据的患者中71%也发热。直肠温度和外耳道近端温度分别能检测出约86%的发热患者的发热情况，舌下温度能检测出66%，腋窝温度能检测出32%。直肠温度在老年患者的临床体温测量中最为有用。我们得出结论，在温暖环境中的患者发生的严重感染会导致发热，而仅测量舌下温度时，发热情况往往会被漏检。
