title: Human temperatures for syndromic surveillance in the emergency department: data from the autumn wave of the 2009 swine flu (H1N1) pandemic and a seasonal influenza outbreak.
abstract: BACKGROUND
  The emergency department (ED) increasingly acts as a gateway to the evaluation and treatment of acute illnesses. Consequently, it has also become a key testing ground for systems that monitor and identify outbreaks of disease. Here, we describe a new technology that automatically collects body temperatures during triage. The technology was tested in an ED as an approach to monitoring diseases that cause fever, such as seasonal flu and some pandemics.
  
  
  METHODS
  Temporal artery thermometers that log temperature measurements were placed in a Boston ED and used for initial triage vital signs. Time-stamped measurements were collected from the thermometers to investigate the performance a real-time system would offer. The data were summarized in terms of rates of fever (temperatures ≥100.4 °F [≥38.0 °C]) and were qualitatively compared with regional disease surveillance programs in Massachusetts.
  
  
  RESULTS
  From September 2009 through August 2011, 71,865 body temperatures were collected and included in our analysis, 2073 (2.6 %) of which were fevers. The period of study included the autumn-winter wave of the 2009-2010 H1N1 (swine flu) pandemic, during which the weekly incidence of fever reached a maximum of 5.6 %, as well as the 2010-2011 seasonal flu outbreak, during which the maximum weekly incidence of fever was 6.6 %. The periods of peak fever rates corresponded with the periods of regionally elevated flu activity.
  
  
  CONCLUSIONS
  Temperature measurements were monitored at triage in the ED over a period of 2 years. The resulting data showed promise as a potential surveillance tool for febrile disease that could complement current disease surveillance systems. Because temperature can easily be measured by non-experts, it might also be suitable for monitoring febrile disease activity in schools, workplaces, and transportation hubs, where many traditional syndromic indicators are impractical. However, the system's validity and generalizability should be evaluated in additional years and settings.
authors.affiliation: University Emergency Medical Services, Gates Vascular Institute, Buffalo, NY, USA.|Previous address: Emergency Department of Beth Israel Deaconess Medical Center, Boston, MA, USA.
authors.forename: Samantha F
authors.initials: SF
authors.lastname: Bordonaro
authors.affiliation: Department of Emergency Medicine, Saint Joseph Mercy Hospital, Ann Arbor, MI, USA.|Department of Emergency Medicine, University of Michigan, Ann Arbor, MI, USA.|Previous address: Emergency Department of Beth Israel Deaconess Medical Center, Boston, MA, USA.
authors.forename: Daniel C
authors.initials: DC
authors.lastname: McGillicuddy
authors.affiliation: Exergen Corporation, Watertown, MA, USA.|Department of Physics, Harvard University, Cambridge, MA, USA.
authors.forename: Francesco
authors.initials: F
authors.lastname: Pompei
authors.affiliation: Department of Physics, Harvard University, Cambridge, MA, USA.
authors.forename: Dmitriy
authors.initials: D
authors.lastname: Burmistrov
authors.affiliation: Data Scientist, Seattle, WA, USA.
authors.forename: Charles
authors.initials: C
authors.lastname: Harding
authors.affiliation: Department of Emergency Medicine, Beth Israel Deaconess Medical Center, One Deaconess Road, W-CC2, Boston, 02215, MA, USA. lsanche1@bidmc.harvard.edu.|Harvard Medical School, Boston, MA, USA. lsanche1@bidmc.harvard.edu.
authors.forename: Leon D
authors.initials: LD
authors.lastname: Sanchez
mesh_terms: D001900:Boston / Q000453:epidemiology; D004196:Disease Outbreaks; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D053118:Influenza A Virus, H1N1 Subtype; D007251:Influenza, Human / Q000453:epidemiology*; D008297:Male; D008875:Middle Aged; D011159:Population Surveillance / Q000379:methods*; D012621:Seasons; D013696:Temperature