title: Temperature measurement in the adult emergency department: oral, tympanic membrane and temporal artery temperatures versus rectal temperature.
abstract: OBJECTIVE
  The objective was to compare agreement between three non-invasive measures of temperature and rectal temperatures and to estimate the sensitivity and specificity of these measures to detect a rectal temperature of 38°C or higher.
  
  
  METHODS
  We conducted a study of the diagnostic accuracy of oral, tympanic membrane (TM) and temporal artery (TA) thermometry to measure fever in an urban emergency department (ED). Data were collected from adult patients who received rectal temperature measurement. Bland-Altman analysis was performed; sensitivity, specificity and 95% CIs were calculated.
  
  
  RESULTS
  987 patients were enrolled. 36% of the TM and TA readings differed by 0.5°C or more from rectal temperatures, 50% of oral temperatures. TM measures were most precise-the SD of the difference from rectal was 0.4°C TM, and 0.6°C for oral and TA (p<0.001). The sensitivities of a 38°C cutpoint on oral, TM and TA measures to detect a rectal temperature of 38°C or higher were: 37.0%, 68.3% and 71.1%, respectively (oral vs TM and TA p<0.001). The corresponding specificities were 99.4%, 98.2% and 92.3% (oral, TM and TA) with oral specificity significantly higher than the other two methods (p<0.01). TM and TA cutpoints of 37.5°C provided greater than 90% sensitivity to detect fever with specificity of 90% and 72%, respectively.
  
  
  CONCLUSIONS
  None of the non-invasive methods met benchmarks for diagnostic accuracy using the criterion of 38°C to detect rectal temperature of 38°C. A TM cutpoint of 37.5°C provides maximum diagnostic accuracy of the three non-invasive measures.
authors.affiliation: Department of Emergency Medicine, Albert Einstein College of Medicine, Bronx, New York, USA.
authors.forename: Polly E
authors.initials: PE
authors.lastname: Bijur
authors.affiliation: Department of Emergency Medicine, Albert Einstein College of Medicine, Bronx, New York, USA.
authors.forename: Purvi D
authors.initials: PD
authors.lastname: Shah
authors.affiliation: Department of Emergency Medicine, Albert Einstein College of Medicine, Bronx, New York, USA.
authors.forename: David
authors.initials: D
authors.lastname: Esses
mesh_terms: D019985:Benchmarking; D001831:Body Temperature; D003430:Cross-Sectional Studies; D004636:Emergency Service, Hospital; D005260:Female; D005334:Fever / Q000175:diagnosis*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012007:Rectum; D012680:Sensitivity and Specificity; D013699:Temporal Arteries; D062125:Thermometry / Q000295:instrumentation*; D014218:Triage; D014432:Tympanic Membrane
keywords: clinical assessment; emergency department; equipment evaluation