Akinbami Felix O, Orimadegun Adebola E, Tongo Olukemi O, Okafor Olubukola O, Akinyinka Olusegun O
Department of Paediatrics, University College Hospital, Ibadan, Nigeria.
BMC Res Notes. 2010 Apr 20;3:108. doi: 10.1186/1756-0500-3-108.
Clinical thermometry is the objective method for temperature measurements but tactile assessment of fever at home is usually the basis for seeking medical attention especially where the cost and level of literacy preclude the use of thermometers. This study was carried out to determine the reliability of tactile perception of fever by caregivers, nurses and house physicians in comparison to rectal thermometry and also the use of commonly practiced surface of the hand in the care of ill children. All caregivers of children aged 6 to 59 months who presented to the emergency department were approached consecutively at the triage stage but 182 children participated. Each child had tactile assessment of fever using palmar and dorsal surfaces of the hand by the caregivers, House Physicians and Nursing Officers. Rectal temperature was also measured and read independently by nurses and house physicians. Comparisons were made between tactile assessments and thermometer readings using a cut-off for fever, 38.0 degrees C and above.
The caregivers' perception of fever had a sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of 95%, 23%, 66% and 73%, respectively compared with 93%, 26%, 67% and 69%, respectively for nursing officers. Irrespective of the groups studied, 77.1% of 336 assessors opined that the dorsal surface of the hand was more sensitive in tactile assessment of temperature and the frequently used site for assessment of fever were the head (35.6%) and neck (33.3%). Tactile assessment of temperature over-detected fever in >/= 24% of cases among the three groups of assessors.
The present study suggests that tactile assessment of temperature may over estimate the prevalence of fever, it does not detect some cases and the need for objective measurement of temperature is emphasised in paediatric emergency care.
临床体温测量是一种客观的体温测量方法，但在家中通过触觉评估发热情况通常是寻求医疗救治的依据，尤其是在成本和文化水平限制了温度计使用的地区。本研究旨在确定与直肠体温测量相比，护理人员、护士和住院医师通过触觉感知发热的可靠性，以及在照顾患病儿童时常用的手部表面的使用情况。在分诊阶段，连续接触了所有前往急诊科就诊的6至59个月大儿童的护理人员，但有182名儿童参与。每位儿童由护理人员、住院医师和护士使用手掌和手背部进行发热的触觉评估。护士和住院医师还独立测量并读取直肠温度。使用38.0摄氏度及以上的发热临界值，对触觉评估和温度计读数进行比较。
与护士分别为93%、26%、67%和69%相比，护理人员对发热的感知灵敏度、特异性、阳性预测值（PPV）和阴性预测值（NPV）分别为95%、23%、66%和73%。无论研究的是哪个组，336名评估者中有77.1%认为手背部在温度触觉评估中更敏感，评估发热时常用的部位是头部（35.6%）和颈部（33.3%）。在三组评估者中，超过24%的病例中温度的触觉评估高估了发热情况。
本研究表明，温度的触觉评估可能高估了发热的患病率，它不能检测到一些病例，并且强调了在儿科急诊护理中进行客观体温测量的必要性。
