Reece Ryan J, Hughes Mary
Emergency Medicine, Michigan State University, Flint, USA.
Osteopathic Medical Specialties, Michigan State University, Lansing, USA.
Cureus. 2022 Feb 9;14(2):e22047. doi: 10.7759/cureus.22047. eCollection 2022 Feb.
Background Inaccurate vital signs may lead to inadequate treatment and skew the differential diagnosis in patients presenting to the emergency department (ED), and thus could cause a delay in diagnosis and treatment. Our study sought to evaluate and compare oral and rectal temperatures in patients with medical conditions that may have fever as part of their presentation to the ED. Objectives To determine if oral and rectal temperatures correlate in patients with medical conditions who have a fever, dry mucous membranes, and are warm to the touch on exam. To identify which patient presentations are more likely to have incongruous temperatures. Our hypothesis is that digital oral thermometers are inaccurate and understate the temperature in patients who present with dry mucous membranes and tactile warmth. Methods A prospective cohort of adult patients in the ED was asked to consent to the comparison of rectal temperature if they presented with a medical condition that could result in a fever. Oral and rectal (core) temperatures were obtained, along with demographic data, chief complaint, current medications, recent ingestion of warm or cold liquids, use of antipyretics, and the treating physician's assessment of mucous membrane dryness and tactile warmth. Results A total of 111 patients were enrolled in the study. 55.8% of patients were male, and the mean age was 61 years. The most common presenting complaint was lower respiratory tract related; 87% had dry mucous membranes, and 85.5% were warm to the touch. Fever or hypothermia was missed in 55 patients (49.5%) if only oral temperatures were obtained. Patients were more likely to consent if their doctor was concerned about a fever and requested a rectal temperature as part of their workup. Conclusions This is one of the first studies to evaluate the difference between oral and rectal routes of obtaining body temperature in the ED in adult patients. Our data reveal that many fevers are "missed" if only oral temperatures are used in medical decision-making in patients with dry mouths and with tactile warmth. Our study is limited by the small sample size and the potential for selection bias.
生命体征不准确可能导致治疗不足，并使急诊科（ED）患者的鉴别诊断出现偏差，进而可能导致诊断和治疗延误。我们的研究旨在评估和比较因可能发热而前来急诊科就诊的患者的口腔温度和直肠温度。
确定患有发热、口腔黏膜干燥且体检时触摸感觉发热的内科疾病患者的口腔温度和直肠温度是否相关。确定哪些患者表现更可能出现体温不一致的情况。我们的假设是，数字式口腔温度计不准确，会低估口腔黏膜干燥且触摸感觉发热的患者的体温。
前瞻性队列研究，要求急诊科成年患者如果因可能导致发热的内科疾病就诊，同意进行直肠温度比较。获取口腔温度和直肠（核心）温度，以及人口统计学数据、主要症状、当前用药、近期摄入温热或冷饮情况、使用退烧药情况，以及主治医生对口腔黏膜干燥程度和触摸感觉发热情况的评估。
共有111名患者纳入研究。55.8%的患者为男性，平均年龄为61岁。最常见的主要症状与下呼吸道有关；87%的患者口腔黏膜干燥，85.5%的患者触摸感觉发热。如果仅获取口腔温度，55名患者（49.5%）的发热或体温过低被漏诊。如果医生担心发热并要求将直肠温度作为检查的一部分，患者更有可能同意。
这是首批评估成年患者在急诊科通过口腔和直肠途径获取体温差异的研究之一。我们的数据显示，如果在口干且触摸感觉发热的患者的医疗决策中仅使用口腔温度，许多发热情况会被“漏诊”。我们的研究受样本量小和存在选择偏倚的可能性所限。
