1、PDF外文：http:/ 2500 字 附录一：英文技术资料翻译 英文原文： Emerg Infect Dis. 2008 August； 14(8): 12551258. doi: 10.3201/eid1408.080059 PMCID: PMC2600390 Cutaneous Infrared Thermometry for Detecting Febrile Patients Pierre Hausfater, Yan Zhao,Stphanie Defrenne, Pascale Bonnet, and Bruno Riou* Aut
2、hor informationCopyright 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 departm
3、ent. 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 eff
4、orts 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 temperatu
5、res (13). Infrared thermal imaging devices have been proposed as a noncontact and noninvasive method for detecting fever (46). However, few studies have assessed their capacity for accurate detection of febrile patients in clinical settings. Therefore, we undertook a prospective study in an emergenc
6、y 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 (Comit de Protection des Personnes se Prtant la Recherche Bio
7、mdicale Piti-Salptrire, 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),
8、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 t
9、emperature (79). 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 c
10、utaneous 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 thr
11、ough 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 measur
12、ed 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 >38.0C. The second objective was to compare measurements of cutaneous temperature and ty
13、mpanic 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
14、 Fisher exact method. Bias, precision (in absolute values and percentages), and number of outliers (defined as a difference >1C) 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 measurement
15、s, 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 cutan
16、eous temperature to predict a tympanic temperature >38C. 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>75 years of age, and 62 (3%) had a ty
17、mpanic temperature >38C. Mean tympanic temperature was 36.7C 0.6C (range 33.7C40.2C), and mean cutaneous temperature was 36.7C 1.7C (range 32.0C42.6C). 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. M
18、ean indoor temperature was 24.8C 1.1C (range 20C28C), and mean outdoor temperature was 10.8C 6.8C (range 0C32C). Reproducibility of infrared measurements was assessed in 256 patients. Bias was 0.04C 0.35C, precision was 0.22C 0.27C (i.e., 0.6 0.7%), and percentage of outliers >1C was 2.3%. Diagno
19、stic performance of cutaneous temperature measurement is shown in Table 1. For the threshold of the definition of tympanic hyperthermia definition used (37.5C, 38C, or 38.5C), sensitivity of cutaneous temperature was lower than that expected and positive predictive value was low. We attempted to det
20、ermine the best threshold (definition of hyperthermia) by using cutaneous temperature to predict a tympanic temperature >38C (Figure 2, panel A). Area under the ROC curve was 0.873 (95% CI 0.8070.917, p<0.001). The best threshold for cutaneous hyperthermia definition was 38.0C, a condition alr
21、eady 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 a
22、nd 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).
