红外温度测试仪中英文翻译

附录一：英文技术资料翻译

英文原文：

Emerg Infect Dis. 2008 August; 14(8): 1255

–

1258.

doi:

10.3201/eid1408.080059

PMCID: PMC2600390

Cutaneous

Infrared

Thermometry

for

Detecting

Febrile

Patients

Pierre Hausfater, Yan Zhao, Sté

phanie Defrenne, Pascale Bonnet, and Bruno Riou*

Author information Copyright and License information

This article has been cited by other articles in PMC.

Abstract

We

assessed

the

accuracy

of

cutaneous

infrared

thermometry,

which

measures

temperature on the forehead, for detecting patients with fever in patients admitted to

an

emergency

department.

Although

negative

predictive

value

was

excellent

(0.99),

positive

predictive

value

was

low

(0.10).

Therefore,

we

question

mass

detection

of

febrile patients by using this method.

Keywords:

Fever,

mass

detection,

cutaneous

infrared

thermometry,

infectious

diseases, emergency, dispatch

Recent efforts to control spread of epidemic infectious diseases have prompted health

officials

to

develop

rapid

screening

processes

to

detect

febrile

patients.

Such

screening may take place at hospital entry, mainly in the emergency department, or at

airports to detect travelers with increased body temperatures (1

–

3). Infrared thermal

imaging

devices

have

been

proposed

as

a

noncontact

and

noninvasive

method

for

detecting fever (4

–

6). However, few studies have assessed their capacity for accurate

detection of febrile patients in clinical settings. Therefore, we undertook a prospective

study in an emergency department to assess diagnostic accuracy of infrared thermal

imaging.

The Study

The study was performed in

an emergency department

of a large academic hospital

(1,800

beds)

and

was

reviewed

and

approved

by

our

institutional

review

board

(Comité

de

Protection

des

Personnes

se

Prê

tant

à

la

Recherche

Biomé

dicale

Pitié

-Salpê

triè

re, Paris, France). Patients admitted to the emergency department were

assessed

by

a

trained

triage

nurse,

and

several

variables

were

routinely

measured,

including

tympanic

temperature

by

using

an

infrared

tympanic

thermometer

(Pro

4000; Welch Allyn, Skaneateles Falls, NY

, USA), systolic and diastolic arterial blood

pressure, and heart rate.

Tympanic temperature was measured twice (once in the left ear and once in the right

ear).

This

temperature

was

used

as

a

reference

because

it

is

routinely

used

in

our

emergency

department

and

is

an

appropriate

estimate

of

central

core

temperature

(7

–

9).

Cutaneous

temperature

was

measured

on

the

forehead

by

using

an

infrared

thermometer

(Raynger

MX;

Raytek,

Berlin,

Germany)

(Figure

1).

Rationale

for

an

infrared thermometer device instead of a larger thermal scanner was that we wanted to

test a method (i.e., measurement of forehead cutaneous temperature by using a simple

infrared

thermometer)

and

not

a

specific

device.

The

forehead

region

was

chosen

because it is

more reliable than the region

behind the eyes

(5,10). The latter region

may

not

be

appropriate

for

mass

screening

because

one

cannot

accurately

measure

temperature

through

eyeglasses,

which

are

worn

by

many

persons.

Outdoor

and

indoor temperatures were also recorded.

Figure 1

Measurement of cutaneous temperature with an infrared thermometer. A) The device

is placed 20 cm from the forehead. B) As soon as the examiner pulls the trigger, the

temperature measured is shown on the display. Used with permission.

The

main

objective

of

our

study

was

to

assess

diagnostic

accuracy

of

infrared

thermometry

for

detecting

patients

with

fever,

defined

as

a

tympanic

temperature

>38.0°

C.

The

second

objective

was

to

compare

measurements

of

cutaneous

temperature

and

tympanic

temperature,

with

the

latter

being

used

as

a

reference point. Data are expressed as mean ±

standard deviation (SD) or percentages

and their 95% confidence intervals (CIs). Comparison of 2 means was performed by

using the Student t test, and comparison of 2 proportions was performed by using the

Fisher exact method. Bias, precision (in absolute values and percentages), and number

of outliers (defined as a difference >1°

C) were also recorded. Correlation between 2

variables

was

assessed

by

using

the

least

square

method.

The

Bland

and

Altman

method was used to compare 2 sets of measurements, and the limit of agreement was

defined

as

±

2

SDs

of

the

differences

(11).

We

determined

the

receiver

operating

characteristic (ROC) curves and calculated the area under the ROC curve and its 95%

CI.

The

ROC

curve

was

used

to

determine

the

best

threshold

for

the

definition

of

hyperthermia for cutaneous temperature to predict a tympanic temperature >38°

C. We

performed

multivariate

regression

analysis

to

assess

variables

associated

with

the

difference

between

tympanic

and

infrared

measurements.

All

statistical

tests

were

2-sided,

and

a

p

value

<0.05

was

required

to

reject

the

null

hypothesis.

Statistical

analysis was performed by using Number Cruncher Statistical Systems 2001 software

(Statistical Solutions Ltd., Cork, Ireland).

A total of 2,026 patients were enrolled in the study: 1,146 (57%) men and 880 (43%)

women 46 ±

19 years of age (range 6

–

103 years); 219 (11%) were >75 years of age,

and

62

(3%)

had

a

tympanic

temperature

>38°

C.

Mean

tympanic

temperature

was

36.7°

C ±

0.6°

C (range 33.7°

< br>C

–

40.2°

C), and mean cutaneous temperature was 36.7°

C

±

1.7°

C (range 32 .0°

C

–

42.6°

C). Mean systolic arterial blood pressure was 130 ±

19

mm Hg, mean diastolic blood pressure was 79 ±

13 mm Hg, and mean heart rate was

86 ±

17 beats/min. Mean indoor temperature was 24.8°

C ±

1.1°

C (range 20°

C

–

28°

C),

and

mean

outdoor

temperature

was

10.8°

C

±

6.8°

C

(range

0°

C

–

32°

C).

Reproducibility

of

infrared

measurements

was

assessed

in

256

patients.

Bias

was

0.04°

C ±

0.35°

C, precision was 0.22°

C ±

0.27°

C (i.e., 0.6 ±

0.7%), and percentage of

outliers >1°

C was 2.3%.

Diagnostic performance of cutaneous temperature measurement is shown in Table 1.

For the threshold of the definition of tympanic hyperthermia definition used (37.5°

C,

38°

C, or 38.5°

C), sensitivity of cutaneous temperature was lower than that expected

and positive predictive value was low. We attempted to determine the best threshold

(definition

of

hyperthermia)

by

using

cutaneous

temperature

to

predict

a

tympanic

temperature >38°

C (Figure 2, panel A). Area under the ROC curve was 0.873 (95%

CI 0.807

–

0.917, p<0.001). The best threshold for cutaneous hyperthermia definition

was 38.0°

C, a condition already assessed in Table 1. Figure 2, panels B and C shows

the

correlation

between

cutaneous

and

tympanic

temperature

measurements

(Bland

and

Altman

diagrams).

Correlation

between

cutaneous

and

tympanic

measurements

was

poor,

and

the

infrared

thermometer

underestimated

body

temperature

at

low

values and overestimated it at high values. Multiple regression analysis showed that 3

variables

(tympanic

temperature,

outdoor

temperature,

and

age)

were

significantly

(p<0.001) and independently correlated with the magnitude of the difference between

cutaneous and tympanic measurements (Table 2).

Table 1

Assessment

of

diagnostic

performance

of

cutaneous

temperature

in

predicting increased tympanic temperature*

Figure 2

A)

Comparison

of

receiver

operating

characteristic

(ROC)

curves

showing

relationship

between sensitivity (true positive) and 1

–

specificity

(true negative) in

determining

value

of

cutaneous

temperature

for

predicting

various

thresholds

of

hyperthermia ...

Table 2

Variables correlated with magnitude of the difference between cutaneous

and tympanic temperature measurements*

Conclusions

Infrared thermometry does

not

reliably detect febrile patients

because its sensitivity

was

lower

than

that

expected

and

the

positive

predictive

value

was

low,

which

indicated a high proportion of false- positive results. Ng et al. (5) studied 502 patients,

concluded that an infrared thermal imager can appropriately identify febrile patients,

and reported a high area under the ROC curve value (0.972), which is similar to the

area

we

found

in

the

present

study

(0.925).

However,

such

global

assessment

is

of

limited value because of low incidence of fever in the population. Rather than looking

at

positive

predictive

value

or

accuracy,

one

should

determine

negative

predictive

value.

This

determination

might

be

of

greater

consequence

if

one

considers

an

air

traveler population or a population entering a hospital.

Ng et

al. (5) identified

outdoor temperature

as

a confounding variable in cutaneous

temperature measurement. Our study identified age as a variable that interferes with

cutaneous measurement, but the role of gender is less obvious. Older persons showed

impaired

defense

(stability)

of

core

temperatures

during

cold

and

heat

stresses,

and

their cutaneous vascular reactivity was reduced (12,13).

Use of a simple infrared thermometry, rather than sophisticated imaging, should not

be

considered

a

limitation

because

this

method

concerns

the

relationship

between

cutaneous and central core temperatures. We can extrapolate our results to any devices

that

estimate

cutaneous

temperature

and

the

software

used

to

average

it.

Our

study

attempted

to

detect

febrile

patients,

not

infected

patients.

For

mass

detection

of

infection, focusing on fever means that nonfebrile patients are not detected. This last

point

is

useful

because

fever

is

not

a

constant

phenomenon

during

an

infectious

disease, antipyretic drugs may have been taken by patients, and a hypothermic rather

than hyperthermic reaction may occur during an infectious process.

In

conclusion,

we

observed

that

cutaneous

temperature

measurement

by

using

infrared thermometry does not provide a reliable basis for screening outpatients who

are febrile because the gradient between cutaneous and core temperatures is markedly

influenced

by

patient’s

age

and

environmental

characteristics.

Mass

detection

of

febrile patients by using this technique cannot be envisaged without accepting a high

rate of false-positive results.

Acknowledgment

We thank David Baker for reviewing the study was supported by the

Direction Gé

né

rale de la Santé

, Ministè

re de la Santé

et de la Solidarité

, Paris, France.

Biography

?

Dr

Hausfater

is

an

internal

medicine

specialist

in

the

emergency

department

of

Centre

Hospitalier

Universitaire

Pitié

-Salpê

triè

re

in

Paris.

His

primary

research

interests are biomarkers of infection and inflammatory and infectious diseases.

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