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OVERVIEWED care providers have long debated which of the various methods of temperature measurement of pediatric patients is best. While the efficacy and accuracy of temporal artery, tympanic membrane, axillary, and infrared temperature measurement have been studied, the gold standard has been rectal temperature measurement. But despite its accuracy, this method causes children with noninfectious complaints and their families unnecessary distress and adds significant time to the triage process. In response, a group of ED staff nurses at a multihospital health system conducted an evidence-based quality improvement project to determine the best practice for accurate temperature measurement in children younger than five years who presented to the ED. The project included an exhaustive literature search, a review of relevant studies, the development of a table of evidence, a presentation of the findings, and recommendations for practice change. This article describes the project and the adoption of temporal artery thermometry, a painless, noninvasive screening method that provided consistently accurate temperature measurement as well as increased patient and nurse satisfaction and a shorter triage process.

Monitoring core body temperature (Tc) during training and competitions, especially in a hot environment, can help enhance an athlete’s performance, as well as lower the risk for heat stroke. Accordingly, a noninvasive sensor that allows reliable monitoring of Tc would be highly beneficial in this context. One such novel non-invasive sensor was recently introduced onto the market (CORE, greenTEG, Rümlang, Switzerland), but, to our knowledge, a validation study of this device has not yet been reported. Therefore, the purpose of this study was to evaluate the validity and reliability of the CORE sensor. In Study I, 12 males were subjected to a low-to-moderate heat load by performing, on two separate occasions several days apart, two identical 60-min bouts of steady-state cycling in the laboratory at 19 °C and 30% relative humidity. In Study II, 13 males were subjected to moderate-to-high heat load by performing 90 min of cycling in the laboratory at 31 °C and 39% relative humidity. In both cases the core body temperatures indicated by the CORE sensor were compared to the corresponding values obtained using a rectal sensor (Trec). The first major finding was that the reliability of the CORE sensor is acceptable, since the mean bias between the two identical trials of exercise (0.02 °C) was not statistically significant. However, under both levels of heat load, the body temperature indicated by the CORE sensor did not agree well with Trec, with approximately 50% of all paired measurements differing by more than the predefined threshold for validity of ≤0.3 °C. In conclusion, the results obtained do not support the manufacturer’s claim that the CORE sensor provides a valid measure of core body temperature.

PurposeTo compare the perceptual responses and interleukin-6 (IL-6) concentration following rectal temperature-matched dry heat exposure (DH) and hot water immersion (HWI).MethodsTwelve healthy young adults (BMI 23.5 ± 3.6 kg/m2; age: 25.8 ± 5.7 years) underwent 3 trials in randomised order: DH (air temperature 68.9 °C), HWI (water temperature 37.5 °C), and thermoneutral dry exposure (CON, air temperature 27.3 °C). Blood samples to determine IL-6 plasma concentration were collected; basic affect and thermal comfort, rectal and skin temperature (Tskin) were assessed throughout the intervention.ResultsRectal temperature (Trec) did not differ between DH (end temperature 38.0 ± 0.4 °C) and HWI (37.9 ± 0.2 °C, P = 0.16), but was higher compared with CON (37.0 ± 0.3 °C; P ≤ 0.004). Plasma IL-6 concentration was similar after DH (pre to post: 0.8 ± 0.5 to 1.4 ± 1.5 pg·ml−1) and HWI (0.5 ± 0.2 to 0.9 ± 0.6 pg·ml−1; P = 0.46), but higher compared with CON (0.6 ± 0.5 to 0.6 ± 0.4 pg·ml−1; P = 0.01). At the end of the intervention, basic affect and thermal comfort were most unfavourable during DH (Basic affect; DH: − 0.7 ± 2.9, HWI: 0.8 ± 1.9, CON 1.9 ± 1.9, P ≤ 0.004; Thermal comfort; 2.6 ± 0.8, HWI: 1.4 ± 0.9 and CON: 0.2 ± 0.4; P ≤ 0.004). Mean Tskin was highest for DH, followed by HWI, and lowest for CON (DH: 38.5 ± 1.3 °C, HWI: 36.2 ± 0.5 °C, CON: 31.6 ± 0.7 °C, P < 0.001).ConclusionThe IL-6 response did not differ between DH and HWI when matched for the elevation in Trec. However, thermal comfort was lower during DH compared to HWI, which may be related to the higher Tskin during DH.

The aim of this study was to better understand the inflection point of RT and BSTs and measure different body surface temperatures (BSTs) under different temperature-humidity index (THI) conditions. A total of 488 Holstein dairy cows were chosen to manually measure rectal temperature (RT) and BSTs including left side of eye, ear, cheek, forehead, flank, rump, fore udder, and rear udder by infrared thermography for 14 times. Those measurements included six times under high THI (THI > 78), three times under moderate THI (72 ≤ THI ≤ 78), and five times under low THI (THI < 72). Results showed that BSTs were affected by THI conditions (P < 0.01). The THI conditions where mean and maximum forehead temperatures started to increase rapidly (71.4 and 66.8) were lower than that where RT started to increase rapidly (74.1). The correlation coefficients of mean and maximum forehead temperatures to THI were 0.808 and 0.740, and were 0.557 and 0.504 to RT, all showing the highest as compared to other region temperatures with THI and RT, respectively. Thus, we conclude that BSTs are more sensitive to thermal environment than RT, suggesting the variability of BST to reflect body core temperature. In addition, the forehead is a relatively reliable region to assess the heat stress reflecting RT compared to the eye, ear, cheek, flank, rump, fore udder, and rear udder regions.

Several temperature-humidity indexes (THI) have been used to estimate the degree of thermal stress experienced by dairy cows. The present objectives were to develop equations using meteorological variables that predicted rectal temperature of lactating cows in a subtropical environment and compare the goodness of fit of these equations to those using 8 different THI. Rectal temperature was measured between 1500 and 1700h in 1,280 lactating Holstein cows in north central Florida between August and December. Meteorological data recorded in the barn where cows were located included dry bulb temperature (Tdb), relative humidity (RH), dew point temperature, and wind speed. Wet bulb temperature was calculated. In the first series of analyses, regression analysis was used to model rectal temperature using the meteorological variables as well as THI. The r2 using Tdb (0.41) was slightly less than for models using all but one THI (r2 between 0.42 and 0.43). The r2 for equations using Tdb could be improved by adding RH (r2=0.43) or RH and RH2 (r2=0.44) to the model. In the second analysis, regression analysis was performed using forward selection, backward elimination, and stepwise selection procedures with the meteorological variables. All models gave a similar goodness of fit (r2=0.44). An analysis of variance with rectal temperature as a class variable was performed to determine the least squares means of meteorological measurements associated with hyperthermia. A Tdb of 29.7°C was associated with rectal temperature of 39°C, and a Tdb of 31.4°C was associated with rectal temperature of 39.5°C. In conclusion, Tdb is nearly as good a predictor of rectal temperatures of lactating Holsteins in a subtropical environment as THI. Estimates of values of meteorological variables associated with specific rectal temperatures should prove valuable in relating environmental conditions to the magnitude of hyperthermia experienced by heat-stressed cows.

[Display omitted] •The estimation of the PMI is of paramount importance in the field of forensic sciences.•Traditionally, the methodology for its estimation is based on physical variables.•Introducing chemical variables and GAM methodology reduces the error when estimating the PMI.•PMI estimation can be performed in an easy, fast and reliable way using software designed for this purpose. The estimation of the time elapsed since death is of paramount importance in the field of forensic sciences and criminal investigation, owing, among other factors, to the possible legal repercussions. Over the past few years various formulae have been developed to calculate this interval using a combination of different statistical methods and the concentrations of substances found in the vitreous humor. Corrective factors, such as ambient temperature, cause of death or age, which can modify the concentration of these substances and therefore the estimation of the postmortem interval, have been incorporated into models. In this paper five simple and reliable models to estimate PMI based the on the analysis of potassium, hypoxanthine and urea in the vitreous humor are presented. Corrective factors, such as body weight, rectal temperature and ambient temperature, which can influence the estimation of this interval have been incorporated into the formulae. Finally, the R2 and the mean squared error have been calculated for each model in order to select the best of the five. A free software program which calculates the PMI from the model and parameters used is available from the authors. It provides quick and reliable results as well as the error committed and R2 for each case.

Background Measuring rectal temperature in children is the gold standard, but ear or forehead measures are less traumatic and faster. The quality of non-invasive devices has improved but concerns remain whether they are reliable enough to substitute rectal thermometers. The aim was to evaluate in a real-life children population whether the forehead or ear temperature measurements could be used in screening to detect fever and if the agreement with the rectal temperature for different age groups is acceptable for clinical use. Methods Cross-sectional clinical study comparing temporal and tympanic temperatures to rectal temperature in 0–18-year-old children. The ear thermometer was a Pro 4000 Thermoscan, the temporal Exergen TAT. Rectal temperature ≥ 38.0 °C was defined as fever. Results Among 995 children, 39% had a fever. The ear thermometer had a significantly greater ability to detect fever than the temporal thermometer (AUC 0.972; 95% CI: 0.963–0.981 versus AUC 0.931; 95% CI: 0.915–0.947, p  < 0.0001). Both devices had the lowest sensitivity in the youngest and oldest children, and only the ear thermometer reached a sensitivity above 90% in the 0.5–5-year age group. The Bland-Altman analysis showed that the 95% limits of agreement for the temporal thermometer was between − 1.2 to + 1.5 °C and for the ear thermometer between − 0.97 to + 1.07 °C. Conclusions Based on a large sample of children, the temporal measurement of temperature is not currently recommendable, but with the technology used in this study the ear measurement proved useful for screening purposes, especially among children aged 6 months to 5 years. For the exact measurement of temperature, the rectal method is still recommended.

The estimation of the time since death is an important task in forensic medicine that mainly relies on body cooling in the early post-mortem period. The rectum has been traditionally used to determine the central core temperature after death, though the external auditory canal has been proposed as an alternative site by several authors. The objective of this study was to assess the ability of four body temperature-based methods (Henssge’s rectal nomogram, Henssge’s brain nomogram, and Baccino’s both interval and global formulae based on ear temperature) to estimate the post-mortem interval (PMI). PMI calculations were carried out based on ear and rectal temperature measurements performed with a reference metal probe on 100 inpatient bodies with an average PMI of 4.5 ± 2.5 h. For practical purposes, ear temperature measurements were applied to Henssge’s brain nomogram. All methods could be applied to 81 cases, since high body temperatures prevented the rectal nomogram method from being used in most of the remaining cases. The actual PMI was within the time interval (95% CI) provided by the rectal nomogram method in 72.8% of cases, and in 63.0% to 76.5% of cases when using ear temperature-based methods. The proportions of adequate estimates did not differ statistically between the different methods. When the methods failed to provide a reliable time interval, all except the brain nomogram tended to underestimate the PMI. Similar results were obtained in the subgroup of normothermic patients at the time of death (n = 63), confirming that the PMI calculations had not been biased by the inclusion of patients with thermoregulation disorders. Our findings are in accordance with the published literature which suggests that ear temperature-based methods are as reliable as those based on rectal temperature for estimating the early PMI and that they may be used as quick, simple, and non-invasive methods at the scene, although caution should be taken in interpreting their results given their high error rates. However, further research including field studies is recommended to confirm their practical relevance in forensic casework.

Prehospital management of exertional heat stroke (EHS) consists of monitoring rectal temperature (Tre) while aggressively cooling via cold water immersion. Recent recommendations suggest using central nervous system (CNS) dysfunction to determine cessation of cooling when Tre is not available. We examined cognitive responses of two runners with EHS after a road race. This comparison illustrates the need to use caution with this recommendation, as the manifestation of CNS responses in EHS patients can be unpredictable. The variables in both cases highlight the importance of avoiding using mental status alone when cooling EHS patients and support Tre serving as the main clinical indicator during treatment.

Rectal temperature measurement (RTM) from crime scenes is an important parameter for temperature-based time of death estimation (TDE). Various influential variables exist in TDE methods like the uncertainty in thermal and environmental parameters. Although RTM depends in particular on the location of measurement position, this relationship has never been investigated separately. The presented study fills this gap using Finite Element (FE) simulations of body cooling. A manually meshed coarse human FE model and an FE geometry model developed from the CT scan of a male corpse are used for TDE sensitivity analysis. The coarse model is considered with and without a support structure of moist soil. As there is no clear definition of ideal rectal temperature measurement location for TDE, possible variations in RTM location (RTML) are considered based on anatomy and forensic practice. The maximum variation of TDE caused by RTML changes is investigated via FE simulation. Moreover, the influence of ambient temperature, of FE model change and of the models positioning on a wet soil underground are also discussed. As a general outcome, we notice that maximum TDE deviations of up to ca. 2–3 h due to RTML deviations have to be expected. The direction of maximum influence of RTML change on TDE generally was on the line caudal to cranial.