红外温度测试仪中英文翻译Word文件下载.docx

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PMCID:

PMC2600390

CutaneousInfraredThermometryforDetectingFebrilePatients

PierreHausfater,YanZhao,Sté

phanieDefrenne,PascaleBonnet,andBrunoRiou*

AuthorinformationCopyrightandLicenseinformation

ThisarticlehasbeencitedbyotherarticlesinPMC.

Abstract

Weassessedtheaccuracyofcutaneousinfraredthermometry,whichmeasurestemperatureontheforehead,fordetectingpatientswithfeverinpatientsadmittedtoanemergencydepartment.Althoughnegativepredictivevaluewasexcellent（0.99）,positivepredictivevaluewaslow（0.10）.Therefore,wequestionmassdetectionoffebrilepatientsbyusingthismethod.

Keywords:

Fever,massdetection,cutaneousinfraredthermometry,infectiousdiseases,emergency,dispatch

Recenteffortstocontrolspreadofepidemicinfectiousdiseaseshavepromptedhealthofficialstodeveloprapidscreeningprocessestodetectfebrilepatients.Suchscreeningmaytakeplaceathospitalentry,mainlyintheemergencydepartment,oratairportstodetecttravelerswithincreasedbodytemperatures（1–3）.Infraredthermalimagingdeviceshavebeenproposedasanoncontactandnoninvasivemethodfordetectingfever（4–6）.However,fewstudieshaveassessedtheircapacityforaccuratedetectionoffebrilepatientsinclinicalsettings.Therefore,weundertookaprospectivestudyinanemergencydepartmenttoassessdiagnosticaccuracyofinfraredthermalimaging.

TheStudy

Thestudywasperformedinanemergencydepartmentofalargeacademichospital（1,800beds）andwasreviewedandapprovedbyourinstitutionalreviewboard（Comité

deProtectiondesPersonnessePrê

tantà

laRechercheBiomé

dicalePitié

-Salpê

triè

re,Paris,France）.Patientsadmittedtotheemergencydepartmentwereassessedbyatrainedtriagenurse,andseveralvariableswereroutinelymeasured,includingtympanictemperaturebyusinganinfraredtympanicthermometer（Pro4000;

WelchAllyn,SkaneatelesFalls,NY,USA）,systolicanddiastolicarterialbloodpressure,andheartrate.

Tympanictemperaturewasmeasuredtwice（onceintheleftearandonceintherightear）.Thistemperaturewasusedasareferencebecauseitisroutinelyusedinouremergencydepartmentandisanappropriateestimateofcentralcoretemperature（7–9）.Cutaneoustemperaturewasmeasuredontheforeheadbyusinganinfraredthermometer（RayngerMX;

Raytek,Berlin,Germany）（Figure1）.Rationaleforaninfraredthermometerdeviceinsteadofalargerthermalscannerwasthatwewantedtotestamethod（i.e.,measurementofforeheadcutaneoustemperaturebyusingasimpleinfraredthermometer）andnotaspecificdevice.Theforeheadregionwaschosenbecauseitismorereliablethantheregionbehindtheeyes（5,10）.Thelatterregionmaynotbeappropriateformassscreeningbecauseonecannotaccuratelymeasuretemperaturethrougheyeglasses,whicharewornbymanypersons.Outdoorandindoortemperatureswerealsorecorded.

Figure1

Measurementofcutaneoustemperaturewithaninfraredthermometer.A）Thedeviceisplaced20cmfromtheforehead.B）Assoonastheexaminerpullsthetrigger,thetemperaturemeasuredisshownonthedisplay.Usedwithpermission.

Themainobjectiveofourstudywastoassessdiagnosticaccuracyofinfraredthermometryfordetectingpatientswithfever,definedasatympanictemperature>

38.0°

C.Thesecondobjectivewastocomparemeasurementsofcutaneoustemperatureandtympanictemperature,withthelatterbeingusedasareferencepoint.Dataareexpressedasmean±

standarddeviation（SD）orpercentagesandtheir95%confidenceintervals（CIs）.Comparisonof2meanswasperformedbyusingtheStudentttest,andcomparisonof2proportionswasperformedbyusingtheFisherexactmethod.Bias,precision（inabsolutevaluesandpercentages）,andnumberofoutliers（definedasadifference>

1°

C）werealsorecorded.Correlationbetween2variableswasassessedbyusingtheleastsquaremethod.TheBlandandAltmanmethodwasusedtocompare2setsofmeasurements,andthelimitofagreementwasdefinedas±

2SDsofthedifferences（11）.Wedeterminedthereceiveroperatingcharacteristic（ROC）curvesandcalculatedtheareaundertheROCcurveandits95%CI.TheROCcurvewasusedtodeterminethebestthresholdforthedefinitionofhyperthermiaforcutaneoustemperaturetopredictatympanictemperature>

38°

C.Weperformedmultivariateregressionanalysistoassessvariablesassociatedwiththedifferencebetweentympanicandinfraredmeasurements.Allstatisticaltestswere2-sided,andapvalue<

0.05wasrequiredtorejectthenullhypothesis.StatisticalanalysiswasperformedbyusingNumberCruncherStatisticalSystems2001software（StatisticalSolutionsLtd.,Cork,Ireland）.

Atotalof2,026patientswereenrolledinthestudy:

1,146（57%）menand880（43%）women46±

19yearsofage（range6–103years）;

219（11%）were>

75yearsofage,and62（3%）hadatympanictemperature>

C.Meantympanictemperaturewas36.7°

C±

0.6°

C（range33.7°

C–40.2°

C）,andmeancutaneoustemperaturewas36.7°

1.7°

C（range32.0°

C–42.6°

C）.Meansystolicarterialbloodpressurewas130±

19mmHg,meandiastolicbloodpressurewas79±

13mmHg,andmeanheartratewas86±

17beats/min.Meanindoortemperaturewas24.8°

1.1°

C（range20°

C–28°

C）,andmeanoutdoortemperaturewas10.8°

6.8°

C（range0°

C–32°

C）.Reproducibilityofinfraredmeasurementswasassessedin256patients.Biaswas0.04°

0.35°

C,precisionwas0.22°

0.27°

C（i.e.,0.6±

0.7%）,andpercentageofoutliers>

Cwas2.3%.

DiagnosticperformanceofcutaneoustemperaturemeasurementisshowninTable1.Forthethresholdofthedefinitionoftympanichyperthermiadefinitionused（37.5°

C,38°

C,or38.5°

C）,sensitivityofcutaneoustemperaturewaslowerthanthatexpectedandpositivepredictivevaluewaslow.Weattemptedtodeterminethebestthreshold（definitionofhyperthermia）byusingcutaneoustemperaturetopredictatympanictemperature>

C（Figure2,panelA）.AreaundertheROCcurvewas0.873（95%CI0.807–0.917,p<

0.001）.Thebestthresholdforcutaneoushyperthermiadefinitionwas38.0°

C,aconditionalreadyassessedinTable1.Figure2,panelsBandCshowsthecorrelationbetweencutaneousandtympanictemperaturemeasurements（BlandandAltmandiagrams）.Correlationbetweencutaneousandtympanicmeasurementswaspoor,andtheinfraredthermometerunderestimatedbodytemperatureatlowvaluesandoverestimateditathighvalues.Multipleregressionanalysisshowedthat3variables（tympanictemperature,outdoortemperature,andage）weresignificantly（p<

0.001）andindependentlycorrelatedwiththemagnitudeofthedifferencebetweencutaneousandtympanicmeasurements（Table2）.

Table1

Assessmentofdiagnosticperformanceofcutaneoustemperatureinpredictingincreasedtympanictemperature*

Figure2

A）Comparisonofreceiveroperatingcharacteristic（ROC）curvesshowingrelationshipbetweensensitivity（truepositive）and1–specificity（truenegative）indeterminingvalueofcutaneoustemperatureforpredictingvariousthresholdsofhyperthermia...

Table2

Variablescorrelatedwithmagnitudeofthedifferencebetweencutaneousandtympanictemperaturemeasurements*

Conclusions

Infraredthermometrydoesnotreliablydetectfebrilepatientsbecauseitssensitivitywaslowerthanthatexpectedandthepositivepredictivevaluewaslow,whichindicatedahighproportionoffalse-positiveresults.Ngetal.（5）studied502patients,concludedthataninfraredthermalimagercanappropriatelyidentifyfebrilepatients,andreportedahighareaundertheROCcurvevalue（0.972）,whichissimilartotheareawefoundinthepresentstudy（0.925）.However,suchglobalassessmentisoflimitedvaluebecauseoflowincidenceoffeverinthepopulation.Ratherthanlookingatpositivepredictivevalueoraccuracy,oneshoulddeterminenegativepredictivevalue.Thisdeterminationmightbeofgreaterconsequenceifoneconsidersanairtravelerpopulationorapopulationenteringahospital.

Ngetal.（5）identifiedoutdoortemperatureasaconfoundingvariableincutaneoustemperaturemeasurement.Ourstudyidentifiedageasavariablethatinterfereswithcutaneousmeasurement,buttheroleofgenderislessobvious.Olderpersonsshowedimpaireddefense（stability）ofcoretemperaturesduringcoldandheatstresses,andtheircutaneousvascularreactivitywasreduced（12,13）.

Useofasimpleinfraredthermometry,ratherthansophisticatedimaging,shouldnotbeconsideredalimitationbecausethismethodconcernstherelationshipbetweencutaneousandcentralcoretemperatures.Wecanextrapolateourresultstoanydevicesthatestimatecutaneoustemperatureandthesoftwareusedtoaverageit.Ourstudyattemptedtodetectfebrilepatients,notinfectedpatients.Formassdetectionofinfection,focusingonfevermeansthatnonfebrilepatientsarenotdetected.Thislastpointisusefulbecausefeverisnotaconstantphenomenonduringaninfectiousdisease,antipyreticdrugsmayhavebeentakenbypatients,andahypothermicratherthanhyperthermicreactionmayoccurduringaninfectiousprocess.

Inconclusion,weobservedthatcutaneoustemperaturemeasurementbyusinginfraredthermometrydoesnotprovideareliablebasisforscreeningoutpatientswhoarefebrilebecausethegradientbetweencutaneousandcoretemperaturesismarkedlyinfluencedbypatient’sageandenvironmentalcharacteristics.Massdetectionoffebrilepatientsbyusingthistechniquecannotbeenvisagedwithoutacceptingahighrateoffalse-positiveresults.

Acknowledgment

WethankDavidBakerforreviewingthemanuscript.ThisstudywassupportedbytheDirectionGé

né

raledela