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Introduction. This study aims to evaluate for the first time the value of visualizing veins by a prototype of a near-infrared (NIR) vascular imaging system for venipuncture in children. Methods. An observational feasibility study of venipunctures in children (0-6 years) attending the clinical laboratory of a pediatric university hospital during a period of 2 months without (n = 80) and subsequently during a period of 1 month with a prototype of an NIR vascular imaging system (n = 45) was conducted. Failure rate (ie, more than 1 puncture) and time of needle manipulation were determined. Results. With the NIR vascular imaging system, failure rate decreased from 10/80 to 1/45 (P = .05) and time decreased from 2 seconds (1-10) to 1 second (1-4, P = .07). Conclusion . This study showed promising results on the value of an NIR vascular imaging system in facilitating venipunctures. [ABSTRACT FROM PUBLISHER]

Background: Accurate determination and detection of fever is essential in the appropriate treatment of pediatric population. It is widely known that improper definitions of fever can cause grave and dangerous consequences in medical procedures. Infrared tympanic thermometry seems a relatively new and popular alternative for traditional measurement in the diagnosis of pediatric fever. However, its accuracy in the diagnosis of fever remains a major concern., Design: Systematic review and meta-analysis., Data Sources: Medline, Ovid, Elsevier, Google Scholar, and Cochrane library., Study Selection: Cross-sectional, prospective design., Data Extraction: Two investigators independently assessed selected studies and extracted data. Disagreements were resolved by discussion with other reviewers., Results: A total of 25 articles were included in our meta-analysis. The summary estimates revealed that the pooled sensitivity was 0.70 (95% confidence interval [CI] = 0.68-0.72), pooled specificity was 0.86 (95% CI = 0.85-0.88), and pooled diagnostic odds ratio was 47.3 (95% CI = 29.76-75.18), for the diagnosis of fever using infrared tympanic thermometry. Additionally, the area under the summary receiver operating characteristic curve was 0.94, and Q* value was 0.87., Conclusion: A total of 25 articles that encompassing 31 studies were analyzed. Based on our meta-analysis, accuracy of infrared tympanic thermometry in diagnosing fever is high. We can cautiously make conclusion that infrared tympanic thermometry should be widely used as fever of thermometer., (© The Author(s) 2014.)

Background: Accurate determination of temperature is important, especially in the diagnosis and treatment of febrile illnesses in the pediatric population. False negative measurement can lead to miss febrile and false positive measurement can cause excessive medical care. Temperatures can be measured at various sites, but we have not found the ideal thermometer yet. As a relatively new and popular alternative over traditional methods, infrared ear thermometry has many advantages, but its accuracy remains a major concern., Design: Systematic review and meta-analysis., Data Sources: Medline, Ovid, Elsevier, Google Scholar, Cochrane Library., Study Selection: Cross-sectional, prospective design., Data Extraction: Two investigators independently assessed selected studies and extracted data. Disagreements were resolved by discussion with other reviewers., Results: Mean tympanic temperature was always lower than rectal temperature. The overall pooled (random effects) mean difference between tympanic and rectal temperature was 0.22°C (95% limits of agreement -0.44°C to 1.30°C), which is similar to the within rectal device groups (mercury, 0.21°C, -0.44°C to 1.27°C; electronic, 0.24°C, -0.46°C to 1.34°C). In febrile children group, the pooled mean temperature difference between tympanic and rectal temperature was 0.15°C (95% limits of agreement -0.32°C to 1.10°C)., Conclusion: The mean difference was large and the 95% limits of agreement was wide. The accuracy of infrared ear thermometry in children is poor, and it cannot replace rectal thermometry in clinical practice of children., (© The Author(s) 2014.)

The authors compared axillary skin temperatures (AT) measured with an infrared (IR) thermometer (Lightouch Neonate, Exergen Corp) with rectal temperatures (RT) in 16 newly born term infants under radiant warmers (RW) and in cribs. Twelve stable, growing premature infants in incubators were also studied. This new device may be useful because of safety and rapid results (1 second), but clinical accuracy is unknown. For term infants, mean (SD) RT-AT difference was 0.1 (0.48) degree C under RW and 0.25 (0.17) degree C 2 hours later in cribs. For premature infants in incubators the mean RT-AT difference was 0.09 (0.16) degree C. Axillary temperatures measured by IR thermometer approximate RT for newly born term infants in cribs and stable premature infants in incubators. For newly born term infants under RW, RT-AT differences vary more widely, limiting clinical usefulness in this setting. The device, the unique age of this population, and the RW environment may play a role.

Body temperature is often the sole determinant of whether or not the neutropenic cancer patient is admitted to the hospital for empiric antibiotic therapy. Recently developed infrared tympanic thermometers offer rapid readings, but their accuracy has not been established. We studied two infrared thermometers (FirstTemp and Thermoscan) and a thermistor (IVAC) in children with cancer. Mean infrared measurements did not differ significantly between right and left ear canals, and the mean IVAC temperature did not differ significantly from the left to the right axilla (P greater than 0.05, paired t test). IVAC predictive mode mean temperature was 0.2 degrees C lower than monitor mode mean temperature in the axilla (P less than 0.0001), but 0.1 degree C higher than monitor mode orally (P less than 0.0001). Aiming the infrared instrument at the tympanic membrane using an ear tug resulted in a 0.2 degree C higher mean temperature than casual placement in the ear canal (P less than 0.0001). After compensation for the mean difference in reference oral glass-mercury versus test instrument temperatures, the FirstTemp, Thermoscan, and oral and axillary predictive mode IVAC measurements yielded sensitivities for the detection of fever of 84%, 84%, 82%, and 86%; specificities of 100%, 99%, 100%, and 100%; positive predictive values of 100%, 93%, 100%, and 100%; and negative predictive values of 95%, 98%, 98%, and 98%, respectively. We conclude that each of these instruments detects fever with comparable reliability. Infrared instruments are especially attractive alternatives due to their time efficiency.

For many years, measurement of body temperature in routine medical practice was limited to oral, rectal and axillary sites. Recent introduction of infrared non-contact thermometers for the auditory canal requires the establishing of temperature relationships between the ear and more traditional thermometry sites. Since an auditory canal is exposed to the environment, the infrared readings from it are influenced by ambient temperature. A linear model of thermal gradients in the vicinity of an ear canal allows us to find simple formulas connecting temperatures taken from the ear with those from traditional core sites like bladder or pulmonary artery, in addition to rectal and oral. The formulas contain environment coupling coefficients. Their values have been found experimentally by measuring body temperatures from subjects in a walk-in environmental chamber and from multiple clinical studies. The derived coefficients are used in the Thermoscan PRO-1 Instant Thermometer to calculate core, oral and rectal equivalent temperatures.

This study was designed to determine if temperature readings using a new tympanic thermometer are affected by otitis media. These readings were also compared to a rectal or oral temperature. Eighty-four children with unilateral suppurative or non-suppurative otitis media diagnosed clinically by their pediatricians were enrolled in the study. Temperatures were measured in both ears using the Thermoscan PRO-1 Instant Thermometer and rectally or orally by a glass or electronic predictive thermometer. For 67 children with unilateral suppurative otitis media the mean temperature in infected ears was 0.38 degrees Fahrenheit higher than in uninfected ears (p = .005). Neither temperatures measured in affected nor those from unaffected ears differed significantly from oral or rectal control readings. For 17 children with unilateral non-suppurative otitis media there was no statistically significant difference between temperatures in affected and unaffected ears or between the temperatures in either ear and the oral or rectal control. Our data show that temperatures taken in ears with suppurative otitis media are slightly higher than those in normal ears. This difference is of minimal clinical significance and does not affect the accuracy when compared to oral or rectal control readings.

We examined the effect of moderate ambient temperature variance on the relationship between oral (OT), rectal (RT), and tympanic membrane (TMT) temperature in 21 healthy adults. Calibrated digital electronic thermometers were used to assess OT and RT, while TMT was measured using an infrared detection device and microprocessor. Recordings were made at baseline and after 15 and 20 minutes of exposure to either warm (35 degrees C) or cool (18.3 degrees C) environmental temperatures. Differences were examined for the three temperature sites and times using repeat measures analysis of variance. No significant differences in RT (37.7 degrees +/- 0.3 degrees C; mean +/- SD) were observed at any time. Both OT (+0.5 degrees C) and TMT (+0.7 degrees C) were significantly changed during warm, but not cool exposure, compared to baseline conditions. We conclude that OT and TMT have a predictable relationship to RT at normal ambient temperature. However, in warm examination areas, spuriously elevated OT and TMTs may occur.

One hundred thirty-seven children at the Cleveland Clinic Foundation were enrolled in a study comparing the accuracy and acceptability of tympanic membrane temperatures taken with Thermoscan to rectal or oral temperatures taken by IVAC electronic thermometers. The mean age of the rectal/ear group was 1.2 +/- 0.86 years (range 0.08-5.0 years) with 22 females and 21 males. The mean age of the oral and ear group was 9.0 +/- 4.24 years (range 3-18 years) with 44 females and 50 males. Significantly large (p less than 0.01) correlation coefficients were present between temperatures in the left ear and right ear (0.92), rectal and mean ear (0.77) and oral and mean ear (0.68). The temperature difference between mean ear and rectal measurements was -1.1 degree +/- 0.51 degree C and the temperature difference between the mean ear and oral measurements was -0.20 degrees +/- 0.59 degrees C. A relative lack of correlation between ear and oral temperatures was noted with flat tympanograms, otoscopically diagnosed middle ear effusion, and with red-white or red tympanic membranes. However, small subgroup sizes (6-16) may have contributed to this lack of correlation. Parents and physicians were impressed by the 2.5 second speed of the new technique. However, younger children were nearly as likely to resist and cry with ear as with rectal temperatures. Parents were comfortable with the ease, cleanliness and safety of ear temperatures. While these data indicate a strong correspondence of ear temperatures with oral and rectal temperatures, parents were not as confident of ear temperatures' accuracy.(ABSTRACT TRUNCATED AT 250 WORDS)

A newly marketed device measures body temperature using an ear probe that detects infrared radiation from the tympanic membrane. It is simple to use and gives a reading in 1-2 seconds. Its accuracy was evaluated in a group of children, aged 1 month through 10 years, by comparing it with either rectal (n = 65), or oral (n = 48) temperatures obtained with a standard electronic thermometer, IVAC (San Diego, CA). The average elapsed time between readings was 11 minutes. Overall, 60 rectal and 40 oral temperatures (88.5%) were higher with IVAC than with the aural sensor. The difference ranged from -0.7 degrees C to +2.5 degrees C. The correlations between the infrared ear-probe values and the rectal and oral temperature readings were 0.77 and 0.75, respectively. Because the average reading using the aural sensor was lower than that using the IVAC, the sensitivity of the aural sensor for detecting clinically important levels of fever was low. None of seven patients with a rectal temperature of 39 degrees C or more and only 7 of 27 with a rectal temperature of 38 degrees C or more were identified by the aural sensor as having temperatures above these cutoff levels. Similarly, none of three patients with an oral temperature of 39 degrees C or more and only three of eight with an oral temperature of 38 degrees C or more were identified correctly by the aural sensor. The authors conclude that the aural sensor is unsatisfactory for detecting clinically significant fevers in a pediatric outpatient setting.