Tympanic temperature measurements: Are they reliable in the critically ill? A clinical study of measures of agreement*

Moran, John L.; Peter, John Victor; Solomon, P. J.; Grealy, Bernadette; Smith, Tania; Ashforth, Wendy; Wake, Megan; Peake, Sandra; Peisach, A R

doi:10.1097/01.ccm.0000250318.31453.cb

Cited by 129 publications

(66 citation statements)

References 53 publications

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“…First, it was not possible to blind treating paramedics and in-hospital medical staff to treatment allocation; however, the intensive care of post-cardiac arrest patients by attending medical staff followed standard guidelines, and it is unlikely that prehospital temperature management influenced major decisions by physicians after admission to the hospital. Second, measurement of tympanic temperature may be inferior to some other methods of measurement of core temperature, such as esophageal, bladder, or pulmonary artery temperature 19 ; however, additional funding for the provision of equipment and training for esophageal temperature measurement was not available in our EMS. Also, the present study was terminated before the enrollment of the estimated required sample size.…”

Section: Discussionmentioning

confidence: 99%

Induction of Therapeutic Hypothermia by Paramedics After Resuscitation From Out-of-Hospital Ventricular Fibrillation Cardiac Arrest

et al. 2010

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Background— Therapeutic hypothermia is recommended for the treatment of neurological injury after resuscitation from out-of-hospital cardiac arrest. Laboratory studies have suggested that earlier cooling may be associated with improved neurological outcomes. We hypothesized that induction of therapeutic hypothermia by paramedics before hospital arrival would improve outcome. Methods and Results— In a prospective, randomized controlled trial, we assigned adults who had been resuscitated from out-of-hospital cardiac arrest with an initial cardiac rhythm of ventricular fibrillation to either prehospital cooling with a rapid infusion of 2 L of ice-cold lactated Ringer’s solution or cooling after hospital admission. The primary outcome measure was functional status at hospital discharge, with a favorable outcome defined as discharge either to home or to a rehabilitation facility. A total of 234 patients were randomly assigned to either paramedic cooling (118 patients) or hospital cooling (116 patients). Patients allocated to paramedic cooling received a median of 1900 mL (first quartile 1000 mL, third quartile 2000 mL) of ice-cold fluid. This resulted in a mean decrease in core temperature of 0.8°C ( P =0.01). In the paramedic-cooled group, 47.5% patients had a favorable outcome at hospital discharge compared with 52.6% in the hospital-cooled group (risk ratio 0.90, 95% confidence interval 0.70 to 1.17, P =0.43). Conclusions— In adults who have been resuscitated from out-of-hospital cardiac arrest with an initial cardiac rhythm of ventricular fibrillation, paramedic cooling with a rapid infusion of large-volume, ice-cold intravenous fluid decreased core temperature at hospital arrival but was not shown to improve outcome at hospital discharge compared with cooling commenced in the hospital. Clinical Trial Registration— URL: http://www.anzctr.org.au. Unique identifier: ACTRN12605000179639.

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Section: Discussionmentioning

confidence: 99%

Induction of Therapeutic Hypothermia by Paramedics After Resuscitation From Out-of-Hospital Ventricular Fibrillation Cardiac Arrest

et al. 2010

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“…14 Tympanic temperature had a large variation and lacked correlation (coefficient 0.1) with intrauterine temperature in the study of Banerjee et al 8 Poor correlation of tympanic temperature with core temperature was described in other studies. [36][37][38] Although rectal measurement has some inconvenience, we decided on this method as it is generally considered to be gold standard for clinical temperature measurement. 23,35,37 Conclusions At the beginning of labour, temperature was 37.1°C (2SD 0.7).…”

Section: Discussionmentioning

confidence: 99%

“…In a prospective cohort study, we included all women with a singleton live pregnancy and a gestational age of 36 We excluded women with a planned caesarean section, an immediate indication for delivery or full cervical dilatation on admission, and those with an infant in breech presentation or with a lethal congenital abnormality. Neonatal observation or treatment during the first week after birth was recorded.…”

Section: Patientsmentioning

confidence: 99%

Maternal temperature during labour

Schouten

Wolf

Smit

et al. 2008

BJOG

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Objective The aim of this study was to describe the variation of normal maternal temperature during labour. Design A prospective cohort study. Setting Two hospitals in Amsterdam, the Netherlands. Population All women with a live singleton pregnancy and a gestational age of 36 weeks or more admitted to the delivery ward from June 2000 to January 2002. Methods Maternal temperature was measured rectally every 2–3 hours from admission until the beginning of second stage, and 1‐hour postpartum. Normal labour (n = 843) was defined as gestational age ≥37 weeks, spontaneous onset of labour, rupture of membranes <18 hours before birth, normal progress of labour without the need for augmentation or epidural analgesia and spontaneous vaginal delivery of a healthy infant. The remaining group was classified as abnormal (n = 2209). Main outcome measures Rectal measured temperature in degrees Celsius. Results The mean temperature during labour in the complete study population increased from 37.1°C at the beginning of labour to 37.4°C after 22 hours. Temperature in the abnormal labour group was equal to the normal labour group during the first 3 hours of labour (P > 0.05) but increased thereafter. Conclusions At the beginning of labour, temperature was 37.1°C. Temperature increased slowly during labour and was 37.4°C (2SD 1.2) after 22 hours. The upper 2SD limit for normal temperature did not follow a circadian pattern and time of day is not relevant for the classification of normal versus elevated temperature.

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“…For example, when noninvasive infrared thermometers were introduced, a plethora of studies was published reporting comparisons of body temperature values when measured simultaneously with the infrared thermometer and such established thermal sensors as the pulmonary artery catheter. [1][2][3][4][5] Other examples of method-comparisons include arterial pulse contour versus pulmonary artery thermodilution cardiac output and point-of-care versus laboratory testing of blood glucose levels. [6][7][8] The basic indication for a method-comparison study is the need to determine if two methods for measuring the same thing (e.g., body temperature, cardiac output) do so in an equivalent manner.…”

Section: Introductionmentioning

confidence: 99%

Design, Analysis, and Interpretation of Method-Comparison Studies

Hanneman

2008

AACN Advanced Critical Care

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Clinicians often need to know if a new method of measurement is equivalent to an established one already in clinical use. This paper reviews the methodology of a method-comparison study to assist the clinician with the conduct and evaluation of such studies. Temperature data from one subject are used to illustrate the procedures. Although one would not make decisions based on the findings from one subject, the large number of paired measurements in the data set permits its use for illustrative purposes. Currently available software eliminates the need for tedious statistical computation, but does not reduce the burden of understanding the concepts underlying a method-comparison study and accurate interpretation of the findings. KeywordsBias; Clinical Measurement; Method-comparison; Precision; Temperature With the rapid development and adoption of critical care technology, clinicians increasingly need to know if the newest technique is equivalent to that in current use. Such a question can be answered with a method-comparison study. For example, when noninvasive infrared thermometers were introduced, a plethora of studies was published reporting comparisons of body temperature values when measured simultaneously with the infrared thermometer and such established thermal sensors as the pulmonary artery catheter. [1][2][3][4][5] Other examples of method-comparisons include arterial pulse contour versus pulmonary artery thermodilution cardiac output and point-of-care versus laboratory testing of blood glucose levels. [6][7][8] The basic indication for a method-comparison study is the need to determine if two methods for measuring the same thing (e.g., body temperature, cardiac output) do so in an equivalent manner. The clinical question is one of substitution: Can one measure X with either Method A or Method B and get the same results?In this paper the author discusses, and illustrates with two examples, the design, analysis and interpretation of a method-comparison study. The examples use partial data from a published report of in vitro and in vivo testing of multiple methods of measuring core body temperature in a pre-clinical critical care laboratory setting. 9 Clinicians may wish to conduct a method-comparison study before adopting new technology in practice. This paper provides information on how to do so. At the very least, the information should help clinicians interpret the findings of method-comparison studies encountered in the literature. NIH Public Access Method-Comparison MethodologyA review of terminology precedes discussion of methodology as statistical reporting terms are used inconsistently in the literature. 10 "Accuracy" and "precision" are used often when "bias" and "repeatability" are the properties being assessed. Accuracy is the degree to which an instrument measures the real value of a variable and is assessed by comparing the measurement method with a gold standard that has been calibrated to be highly accurate. In a methodcomparison study, however, the investigator is comparing a l...

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Tympanic temperature measurements: Are they reliable in the critically ill? A clinical study of measures of agreement*

Cited by 129 publications

References 53 publications

Induction of Therapeutic Hypothermia by Paramedics After Resuscitation From Out-of-Hospital Ventricular Fibrillation Cardiac Arrest

Induction of Therapeutic Hypothermia by Paramedics After Resuscitation From Out-of-Hospital Ventricular Fibrillation Cardiac Arrest

Maternal temperature during labour

Design, Analysis, and Interpretation of Method-Comparison Studies

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