Brennan D F, Falk J L, Rothrock S G, Kerr R B
Department of Emergency Medicine, Orlando Regional Medical Center, Florida.
Ann Emerg Med. 1995 Jan;25(1):21-30. doi: 10.1016/s0196-0644(95)70350-0.
Recently published clinical guidelines for the management of febrile children are based on studies that used rectal temperature data to stratify the risk of bacteremia and septic complications. Appropriate management decisions rely on accurate detection and categorization of fever. Accordingly, this study compared the newer infrared tympanic thermometry (ITT) to rectal thermometry in this regard.
Prospective observational study.
Urban teaching hospital ED with annual census of 60,000.
Consecutive children 6 months to 6 years old who had rectal temperatures measured.
Triage nurses recorded rectal temperatures and bilateral ITT temperatures. Temperatures were correlated by Pearson correlation coefficients and compared using paired t tests with significance set at P < .01. Children were categorized by degree of fever using rectal temperature (afebrile, less than 100.4 degrees F; low fever, 100.4 to 102.9 degrees F; and high fever, more than 102.9 degrees F), and the accuracy of ITT in detecting fever and high fever was determined.
Three hundred seventy patients were enrolled in the study. The mean age was 18.4 +/- 11.3 months; boys comprised 56% of patients. The mean temperatures were rectal, 101.0 +/- 2.0 degrees F; right tympanic membrane, 100.4 +/- 1.9 degrees F; and left tympanic membrane, 100.3 +/- 1.9 degrees F. The tympanic membrane temperatures were significantly lower than rectal readings (P << .001 for both right and left versus rectal). Rectal temperatures showed good correlation with both right and left tympanic membrane temperatures (r = .83 and .85, respectively). ITT was 76% sensitive and 92% specific in detecting fever of 100.4 degrees F or more (positive predictive value, 0.92; negative predictive value, 0.76). In the detection of high fever, ITT was only 57% sensitive but 98% specific (positive predictive value, 0.90; negative predictive value, 0.90). Rectal and TM temperatures differed by at least 0.5 degree F in 70% of the patients, 1.0 degree F in 41%, 2.0 degrees F in 12%, and 3.0 degrees F in 3%.
Despite the statistical correlation between ITT and rectal temperatures, the modalities may yield significantly different temperatures. The poor sensitivity of ITT in detecting fever and high fever may result in clinically important miscategorizations of individual patients. Current clinical management that is based on the presence and height of fever may be adversely affected if ITT is used.
最近发布的发热儿童管理临床指南是基于使用直肠温度数据对菌血症和脓毒症并发症风险进行分层的研究。恰当的管理决策依赖于发热的准确检测和分类。因此，本研究在这方面比较了新型红外鼓膜温度计（ITT）和直肠温度计。
前瞻性观察研究。
年接诊量为60000人次的城市教学医院急诊科。
连续纳入的6个月至6岁测量过直肠温度的儿童。
分诊护士记录直肠温度和双侧ITT温度。温度通过Pearson相关系数进行关联，并使用配对t检验进行比较，显著性设定为P <.01。根据直肠温度（无热，低于100.4华氏度；低热，100.4至102.9华氏度；高热，高于102.9华氏度）对儿童发热程度进行分类，并确定ITT检测发热和高热的准确性。
370名患者纳入研究。平均年龄为18.4±11.3个月；男孩占患者的56%。平均温度为直肠温度101.0±2.0华氏度；右鼓膜温度100.4±1.9华氏度；左鼓膜温度100.3±1.9华氏度。鼓膜温度显著低于直肠温度读数（右和左与直肠相比P均<<.001）。直肠温度与右、左鼓膜温度均显示出良好的相关性（分别为r =.83和.85）。ITT检测100.4华氏度及以上发热的敏感度为76%，特异度为92%（阳性预测值为0.92；阴性预测值为0.76）。在检测高热方面，ITT敏感度仅为57%，但特异度为98%（阳性预测值为0.90；阴性预测值为0.90）。70%的患者直肠温度和鼓膜温度相差至少0.5华氏度，41%相差1.0华氏度，12%相差2.0华氏度，3%相差3.0华氏度。
尽管ITT和直肠温度之间存在统计学相关性，但这两种测量方式可能产生显著不同的温度。ITT在检测发热和高热方面的低敏感度可能导致对个体患者在临床上产生重要的分类错误。如果使用ITT，基于发热的存在和程度的当前临床管理可能会受到不利影响。
