Comparison of Temperature Acquisition Methods in the ED

Summary and Comment |
July 15, 2016

Comparison of Temperature Acquisition Methods in the ED

  1. Jennifer L. Wiler, MD, MBA, FACEP

As has been shown with pediatric and critically ill patient populations, noninvasive temperature measurement has poor diagnostic accuracy in adult emergency department patients.

  1. Jennifer L. Wiler, MD, MBA, FACEP

In a study of 987 emergency department (ED) patients (mean age 55 years, 65% female) who received a rectal temperature measurement as part of routine care, researchers assessed the accuracy of oral, tympanic membrane, and temporal artery thermometry.

Overall, the noninvasive temperature readings were inaccurate; they differed by ≥0.5°C from rectal temperatures 36% of the time and from oral temperatures 50% of the time. The most accurate noninvasive method was tympanic membrane thermometry.

The sensitivity and specificity for detecting fever of 38°C or higher measured rectally were as follows:

  • Tympanic membrane: 68% and 98%

  • Temporal artery: 71% and 92%

  • Oral: 37% and 99%

When the cutoff temperature for defining fever was lowered to 37.5°C, the sensitivity and specificity were as follows:

  • Tympanic membrane: 91% and 90%

  • Temporal artery: 91% and 72%

  • Oral: 58% and 97%

Comment

Accurate temperature measurement can be important to patient care. Rectal temperatures have long been considered the gold standard for accurate thermometry, but it is not feasible or appropriate for evaluation of all acute care patients. If hospitals want to continue to use noninvasive modes for temperature collection, then a cutoff value of 37.5°C should be used to define fever, or at least to trigger taking a rectal temperature.

Editor Disclosures at Time of Publication

  • Disclosures for Jennifer L. Wiler, MD, MBA, FACEP at time of publication Leadership positions in professional societies Colorado Medical Society (Member, Board of Directors)

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