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Rectal thermometry (RT) is considered the gold standard for measuring temperature in newborns, despite increasing use of temporal artery thermometry (TT) and axillary thermometry (AT) methods. Few prospective studies compare RT, TT, and AT in a newborn nursery setting. To determine the accuracy and reliability of these methods, we enrolled 205 healthy, full-term newborns. TT displayed higher mean temperatures than RT by 0.25 °F (standard error [SE] = 0.04, P < .001). AT and RT measurements did not significantly differ, with their means differing only by 0.02 °F (SE = 0.04, P = .87). For reliability, RT measurements differed by 0.45 °F (SE = 0.03) in either direction of the models’ predicted mean for each subject. AT and TT measurements varied much less from their predicted means 0.32 °F (SE = 0.02) and 0.34 °F (SE = 0.02), respectively (both P < .001). Assuming mean RT is correct, TT is less accurate than AT. RT showed poor reliability between measurements. AT is an accurate and reliable method of temperature screening in healthy neonates.

Context The use of aural thermometry as a method for accurately measuring internal temperature has been questioned. No researchers have examined whether aural thermometry can accurately measure internal body temperature in patients with exertional heat stroke (EHS). Objective To examine the effectiveness of aural thermometry as an alternative to the criterion standard of rectal thermometry in patients with and those without EHS. Design Cross-sectional study. Setting An 11.3-km road race. Patients or Other Participants A total of 49 patients with EHS (15 men [age = 38 ± 17 years], 11 women [age = 28 ± 10 years]) and 23 individuals without EHS (10 men [age = 62 ± 17 years], 13 women [age = 45 ± 14 years]) who were triaged to the finish-line medical tent for suspected EHS. Main Outcome Measure(s) Rectal and aural temperatures were obtained on arrival at the medical tent for patients with and those without EHS and at 8.3 ± 5.2 minutes into EHS treatment (cold-water immersion) for patients with EHS. Results The mean difference between temperatures measured using rectal and aural thermometers in patients with EHS at medical tent admission was 2.4°C ± 0.96°C (4.3°F ± 1.7°F; mean rectal temperature = 41.1°C ± 0.8°C [106.1°F ± 1.4°F]; mean aural temperature = 38.8°C ± 1.1°C [101.8°F ± 2.0°F]). Rectal and aural temperatures during cold-water immersion in patients with EHS were 40.4°C ± 1.0°C (104.6°F ± 1.8°F) and 38.0°C ± 1.2°C (100.3°F ± 2.2°F), respectively. Rectal and aural temperatures for patients without EHS at medical tent admission were 38.8°C ± 0.87°C (101.9°F ± 1.6°F) and 37.2°C ± 1.0°C (99.1°F ± 1.8°F), respectively. Conclusions Aural thermometry is not an accurate method of diagnosing EHS and should not be used as an alternative to rectal thermometry. Using aural thermometry to diagnosis EHS can result in catastrophic outcomes, such as long-term sequelae or fatality.

Background The aim of this study was to evaluate the comparative precision and accuracy of multiple methods of thermometry used to assess body temperature in healthy adult ferrets. Methods Temperature was measured in 20 healthy ferrets (Mustela putorius furo) using noncontact infrared thermometry, digital thermometry in the rectal, inguinal, and axillary regions, and infrared contact-based thermometer in the ear (tympanic) and on the skin of the dorsal back between the shoulder blades. Temperatures were taken pre- and posthandling, evaluated across the set of ferrets for general precision and effect of handling, and compared to assess accuracy. Intraclass correlation analysis and Bland-Altman agreement analyses with rectal temperature being used as reference were conducted. Results Sample time (before and after physical examination) and day (day #1 and day #2), were found to not to be significantly different with respect to temperature measurements (P > 0.05). Reproducibility was not high for any of the temperature measurement methods, but was moderate for rectal and tympanic ear measures. The lowest mean difference with rectal temperature was found for tympanic thermometry on the dorsal skin when compared with rectal measurement (+0.05° C), as opposed to the other four methods of temperature measurement which ranged in their mean differences when compared with rectal measurement (−7.4 to −0.58° C). Agreement analyses showed constant error and proportional error only for the inguinal temperature method. Conclusions and clinical relevance Temperature measurements due to tympanic thermometers applied on the dorsal skin have some agreement with respect to digital rectal thermometry in ferrets. Following further validating studies on hypothermic and hyperthermic contexts of usage, this less invasive approach may be a useful method for temperature measurement in clinical settings to reduce stress of the patient and increase efficiency without sacrificing accuracy.

BackgroundGuidelines recommend measuring temperature in children presenting with fever using electronic axillary or tympanic thermometers. Non-contact thermometry offers advantages, yet has not been tested against recommended methods in primary care.AimTo compare two different non-contact infrared thermometers (NCITs) to axillary and tympanic thermometers in children aged ≤5 years visiting their GP with an acute illness.Design and settingMethod comparison study with nested qualitative component.MethodTemperature measurements were taken with electronic axillary (Welch Allyn SureTemp®), electronic tympanic (Braun Thermoscan®), NCIT Thermofocus® 0800, and NCIT Firhealth Forehead. Parents rated acceptability and discomfort. Qualitative interviews explored parents’ experiences of the thermometers.ResultsIn total, 401 children were recruited (median age 1.6 years, 50.62% male). Mean difference between the Thermofocus NCIT and axillary thermometer was −0.14°C (95% confidence interval [CI] = −0.21 to −0.06°C); lower limit of agreement was −1.57°C (95% CI = −1.69 to −1.44°C) and upper limit 1.29°C (95% CI = 1.16 to 1.42°C). A second NCIT (Firhealth) had similar levels of agreement; however, the limits of agreement between tympanic and axillary thermometers were also wide. Parents expressed a preference for the practicality and comfort of NCITs, and were mostly negative about their child’s experience of axillary thermometers. But there was willingness to adopt whichever device was medically recommended.ConclusionIn a primary care paediatric population, temperature measurements with NCITs varied by >1°C compared with axillary and tympanic approaches. But there was also poor agreement between tympanic and axillary thermometers. Since clinical guidelines often rely on specific fever thresholds, clinicians should interpret peripheral thermometer readings with caution and in the context of a holistic assessment of the child.

Body temperature reflects the animal health and/or disease conditions. During clinical examination, temperature measurement is a basic step in veterinary medicine. The conventional method used is the rectal thermometry, particularly stressful in some subjects, especially for cats. A less stressful alternative method, such as infrared thermal imaging camera, is used in various fields of medicine for diagnosis, prognosis and correct therapeutic approaches. To evaluate the usefulness of infrared thermal imaging for the assessment of ocular temperature, twenty cats of different breeds (European, Siamese and Persian, 4-6 years old, mean body weight 4.3 ± 0.30 Kg) were enrolled in the study. In order to evaluate the applicability of the ocular temperature assessment through thermal imaging as a tool for measuring the animal's body temperature, the obtained values were compared with the rectal temperature values recorded in each cat by means of a digital thermo-camera. There were no differences between left and right eye; and a difference of about 1.19 °C between the ocular and rectal temperature value was recorded (p 0.0001). Rectal and ocular temperatures were positively correlated (p 0.0001; r = 0.93). In conclusion, we show that ocular temperature is an alternative method for body temperature measurement that can be used in clinical evaluation of cats, especially in cases where rectal temperature recording is not possible.

Background Current options for temperature measurement in children presenting to primary care include either electronic axillary or infrared tympanic thermometers. Non-contact infrared thermometers could reduce both the distress of the child and the risk of cross-infection. Objectives The objective of this study was to compare the use of non-contact thermometers with the use of electronic axillary and infrared tympanic thermometers in children presenting to primary care. Design Method comparison study with a nested qualitative study. Setting Primary care in Oxfordshire. Participants Children aged ≤ 5 years attending with an acute illness. Interventions Two types of non-contact infrared thermometers [i.e. Thermofocus (Tecnimed, Varese, Italy) and Firhealth (Firhealth, Shenzhen, China)] were compared with an electronic axillary thermometer and an infrared tympanic thermometer. Main outcome measures The primary outcome was agreement between the Thermofocus non-contact infrared thermometer and the axillary thermometer. Secondary outcomes included agreement between all other sets of thermometers, diagnostic accuracy for detecting fever, parental and child ratings of acceptability and discomfort, and themes arising from our qualitative interviews with parents. Results A total of 401 children (203 boys) were recruited, with a median age of 1.6 years (interquartile range 0.79–3.38 years). The readings of the Thermofocus non-contact infrared thermometer differed from those of the axillary thermometer by –0.14 °C (95% confidence interval –0.21 to –0.06 °C) on average with the lower limit of agreement being –1.57 °C (95% confidence interval –1.69 to –1.44 °C) and the upper limit being 1.29 °C (95% confidence interval 1.16 to 1.42 °C). The readings of the Firhealth non-contact infrared thermometer differed from those of the axillary thermometer by –0.16 °C (95% confidence interval –0.23 to –0.09 °C) on average, with the lower limit of agreement being –1.54 °C (95% confidence interval –1.66 to –1.41 °C) and the upper limit being 1.22 °C (95% confidence interval 1.10 to 1.34 °C). The difference between the first and second readings of the Thermofocus was –0.04 °C (95% confidence interval –0.07 to –0.01 °C); the lower limit was –0.56 °C (95% confidence interval –0.60 to –0.51 °C) and the upper limit was 0.47 °C (95% confidence interval 0.43 to 0.52 °C). The difference between the first and second readings of the Firhealth thermometer was 0.01 °C (95% confidence interval –0.02 to 0.04 °C); the lower limit was –0.60 °C (95% confidence interval –0.65 to –0.54 °C) and the upper limit was 0.61 °C (95% confidence interval 0.56 to 0.67 °C). Sensitivity and specificity for the Thermofocus non-contact infrared thermometer were 66.7% (95% confidence interval 38.4% to 88.2%) and 98.0% (95% confidence interval 96.0% to 99.2%), respectively. For the Firhealth non-contact infrared thermometer, sensitivity was 12.5% (95% confidence interval 1.6% to 38.3%) and specificity was 99.4% (95% confidence interval 98.0% to 99.9%). The majority of parents found all methods to be acceptable, although discomfort ratings were highest for the axillary thermometer. The non-contact thermometers required fewer readings than the comparator thermometers. Limitations A method comparison study does not compare new methods against a reference standard, which in this case would be central thermometry requiring the placement of a central line, which is not feasible or acceptable in primary care. Electronic axillary and infrared tympanic thermometers have been found to have moderate agreement themselves with central temperature measurements. Conclusions The 95% limits of agreement are > 1 °C for both non-contact infrared thermometers compared with electronic axillary and infrared tympanic thermometers, which could affect clinical decision-making. Sensitivity for fever was low to moderate for both non-contact thermometers. Future work Better methods for peripheral temperature measurement that agree well with central thermometry are needed. Trial registration Current Controlled Trials ISRCTN15413321. Funding This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 24, No. 53. See the NIHR Journals Library website for further project information.

Background and Objectives: Emergency Medical Service (EMS) protocols vary widely and may not implement best practices for exertional heat stroke (EHS). EHS is 100% survivable if best practices are implemented within 30 min. The purpose of this study is to compare EMS protocols to best practices for recognizing and treating EHS. Materials and Methods: Individuals (n = 1350) serving as EMS Medical or Physician Director were invited to complete a survey. The questions related to the EHS protocols for their EMS service. 145 individuals completed the survey (response rate = 10.74%). Chi-Squared Tests of Associations (&chi, 2) with 95% confidence intervals (CI) were calculated. Prevalence ratios (PR) with 95% CI were calculated to determine the prevalence of implementing best practices based on location, working with an athletic trainer, number of EHS cases, and years of directing. All PRs whose 95% CIs excluded 1.00 were considered statistically significant, Chi-Squared values with p values &lt, 0.05 were considered statistically significant. Results: A majority of the respondents reported not using rectal thermometry for the diagnosis of EHS (n = 102, 77.93%) and not using cold water immersion for the treatment of EHS (n = 102, 70.34%). If working with an athletic trainer, EMS is more likely to implement best-practice treatment (i.e., cold-water immersion and cool-first transport-second) (69.6% vs. 36.9%, &chi, 2 = 8.480, p &lt, 0.004, PR = 3.15, 95% CI = 1.38, 7.18). Conclusions: These findings demonstrate a lack of implementation of best-practice standards for EHS by EMS. Working with an athletic trainer appears to increase the likelihood of following best practices. Efforts should be made to improve EMS providers&rsquo, implementation of best-practice standards for the diagnosis and management of EHS to optimize patient outcomes.

Body temperature is an important component in the diagnosis and treatment of disease in canines. The rectal temperature remains the standard of obtaining temperature within the clinical setting, but there are many drawbacks with this method, including time, access, animal stress, and safety concerns. Interest in using infrared thermometry in canines to obtain body temperature has grown as animal scientists and veterinarians search for non-invasive and non-contact methods and locations of obtaining canine temperatures. Here, we review evidence on axillary, auricular, and ocular region canine thermometry and the degree to which measurements in these locations are representative of rectal temperature values. Instrumentation refinement and development, as well as morphologic differences, play an important role in the potential correlation between the rectal temperature and these other locations. These caveats have yet to be fully addressed in the literature, limiting the options for those seeking alternatives to rectal thermometry.Keywords: Auricular, Axillary, Canine, Ocular, Thermometry.

Not much is known about how accurate and reproducible different thermometers are at diagnosing patients with suspected fever. The study aims at evaluating which peripheral thermometers are more accurate and reproducible. We searched Medline, Embase, Scopus, WOS, CENTRAL, and Cinahl to perform: (1) diagnostic accuracy meta-analysis (MA) using rectal mercury-in-glass or digital thermometry as reference, and bivariate models for pooling; (2) network MA to estimate differences in mean temperature between devices; (3) Bland–Altman method to estimate 95% coefficient of reproducibility. PROSPERO registration: CRD42020174996. We included 46 studies enrolling more than 12,000 patients. Using 38 °C (100.4 ℉) as cut-off temperature, temporal infrared thermometry had a sensitivity of 0.76 (95% confidence interval, 0.65, 0.84; low certainty) and specificity of 0.96 (0.92, 0.98; moderate certainty); tympanic infrared thermometry had a sensitivity of 0.77 (0.60, 0.88; low certainty) and specificity of 0.98 (0.95, 0.99; moderate certainty). For all the other index devices, it was not possible to pool the estimates. Compared to the rectal mercury-in-glass thermometer, mean temperature differences were not statistically different from zero for temporal or tympanic infrared thermometry; the median coefficient of reproducibility ranged between 0.53 °C [0.95 ℉] for infrared temporal and 1.2 °C [2.16 ℉] for axillary digital thermometry. Several peripheral thermometers proved specific, but not sensitive for diagnosing fever with rectal thermometry as a reference standard, meaning that finding a temperature below 38 °C does not rule out fever. Fixed differences between temperatures together with random error means facing differences between measurements in the order of 2 °C [4.5 ℉]. This study informs practitioners of the limitations associated with different thermometers; peripheral ones are specific but not sensitive. Electronic supplementary material The online version of this article (10.1007/s11739-020-02556-0) contains supplementary material, which is available to authorized users.

BackgroundMethods and frequency of temperature monitoring in intensive care unit patients vary widely. The recently available SpotOn system uses zero-heat-flux technology and offers a noninvasive method for continuous monitoring of core temperature of critical care patients at risk for alterations in body temperature.ObjectiveTo evaluate agreement between and precision of a zero-heat-flux thermometry system (SpotOn) and continuous rectal and urinary bladder thermometry during fever and defervescence in adult patients in intensive care units.MethodsProspective comparison of SpotOn vs rectal and urinary bladder thermometry in eligible patients enrolled in a randomized clinical trial on the effect of acetaminophen on core body temperature and hemodynamic status.ResultsA total of 748 paired temperature measurements from 38 patients who had both SpotOn monitoring and either continuous rectal or continuous bladder thermometry were analyzed. Temperatures during the study were from 36.6°C to 39.9°C. The mean difference for SpotOn compared with bladder thermometry was −0.07°C (SD, 0.24°C; 95% limits of agreement, ± 0.47°C [−0.54°C, 0.40°C]). The mean difference for SpotOn compared with rectal thermometry was −0.24°C (SD, 0.29°C; 95% limits of agreement, ± 0.57°C [−0.81°C, 0.33°C]). Most differences in temperature between methods were within ± 0.5°C in both groups (96% bladder and 85% rectal).ConclusionsThe SpotOn thermometry system has excellent agreement and good precision and is a potential alternative for noninvasive continuous monitoring of core temperature in critical care patients, especially when alternative methods are contraindicated or not available.

Background Accurate temperature readings, often obtained rectally, are an important part of the initial evaluation of pediatric patients in the Emergency Department. Temporal artery thermometry (TAT) is one way to noninvasively measure temperature. We sought to compare the accuracy of axillary and temporal artery temperatures compared to rectal. Methods This prospective study included children age 0–36 months presenting to the Emergency Department of a large military treatment facility. Rectal, axillary, and temporal artery temperatures were obtained. Test characteristics (sensitivity, specificity, NPV, PPV) were reported. The effect of cutoff values 99.9 °F, 100.4 °F, and 102.2 °F on test characteristics were also evaluated. Results The sensitivities of axillary and temporal artery thermometry to detect rectal fever is 11.5% and 61.5% respectively. Cutoff values did not significantly alter test characteristics. In this study, temporal artery thermometry was 0.2 °C lower than rectal temperature, axillary measurement was 0.9 °C below the reference standard. Mean temperature difference in the febrile group between TAT and rectal thermometry was > 0.5 °C compared with a mean temperature difference 0.05 °C in afebrile patients. Conclusion The findings of our study do not support using axillary thermometry to screen pediatric patients for fever in the emergency department. TAT cannot be recommended as a rectal thermometry replacement where height and duration of fever are used in pediatric disease prediction models. TAT may have a role in screening for fever in the appropriate pediatric patient population like primary orthopedic or trauma presentations where the balance between device precision, data capture and patient comfort may favor use of TAT.

Stress-induced hyperthermia following rectal thermometry is reported in normothermic rats, but appears to be muted or even absent in febrile rats. We therefore investigated whether the use of rectal thermometry affects the accuracy of temperature responses recorded in normothermic and febrile rats. Using intra-abdominally implanted temperature-sensitive radiotelemeters we measured the temperature response to rectal temperature measurement in male Sprague Dawley rats (~ 200 g) injected subcutaneously with Brewer's yeast (20 ml/kg of a 20% Brewer's yeast solution = 4000 mg/kg) or saline (20 ml/kg of 0.9% saline). Rats had been pre-exposed to, or were naive to rectal temperature measurement before the injection. The first rectal temperature measurement was taken in the plateau phase of the fever (18 h after injection) and at hourly intervals thereafter. In normothermic rats, rectal temperature measurement was associated with an increase in abdominal temperature (0.66 ± 0.27 °C) that had a rapid onset (5–10 min), peaked at 15–20 min and lasted for 35–50 min. The hyperthermic response to rectal temperature measurement was absent in febrile rats. Exposure to rectal temperature measurement on two previous occasions did not reduce the hyperthermia. There was a significant positive linear association between temperatures recorded using the two methods, but the agreement interval identified that rectal temperature measured with a thermocouple probe could either be 0.7 °C greater or 0.5 °C lower than abdominal temperature measured with radiotelemeter. Thus, due to stress-induced hyperthermia, rectal thermometry does not ensure accurate recording of body temperature in short-spaced, intermittent intervals in normothermic and febrile rats.

OBJECTIVE To evaluate the effects of restraint time and thermometer insertion depth on rectal temperature measurements in chinchillas and determine the extent of agreement between temperatures measured with 2 tympanic and a rectal thermometer. DESIGN Prospective method comparison study. ANIMALS 47 healthy chinchillas. PROCEDURES Effects of 1- and 2-cm rectal thermometer insertion depths and the effect of manual restraint for up to 5 minutes were evaluated. Near simultaneous temperature measurements were obtained with a human tympanic, a veterinary tympanic, and a rectal thermometer by 2 observers. Duplicate temperature measurements were obtained for each method, and the sequence of measurements was randomized for each animal. RESULTS Rectal temperature readings obtained at a depth of 2 cm were significantly higher (mean ± SD, 1.14 ± 0.77°C [2.05° ± 1.39°F]) than those obtained at 1 cm. After 3 minutes, manual restraint had a significant effect on rectal temperature. The reference interval for rectal temperature in chinchillas with a 2-cm thermometer insertion depth was calculated as 34.9° to 37.9°C (94.8° to 100.2°F). Both tympanic infrared thermometers had significant systematic bias (0.42 ± 0.12°C [0.76° ± 0.22°F]) and proportional bias (0.88 ± 0.14°C [1.58° ± 0.25°F]). The coefficients of reliability for the rectal thermometer, the human tympanic thermometer, and the veterinary tympanic thermometer were 0.86, 0.85, and 0.69, respectively. CONCLUSIONS AND CLINICAL RELEVANCE Rectal thermometer insertion depth and duration of manual restraint had a significant effect on rectal temperature measurements in chinchillas. Because of significant systematic and proportional bias, tympanic thermometry was not considered a suitable replacement for rectal thermometry in chinchillas.

Context: Death from exertional heat stroke (EHS) is preventable when evidence-based guidelines are followed. The assessment of core body temperature using rectal thermometry and the treatment of cold-water immersion for EHS has been established as the standard of care; however, rectal thermometry is still controversial. Athletic trainers (ATs) may lack knowledge and comfort with this skill, which could impact implementation. Objective: Examine ATs' current practices, attitudes, and perceptions regarding EHS before and after an educational intervention. Design: Prequantitative/postquantitative experimental. Setting: Classroom. Patients or Other Participants: Twenty-five ATs in various athletic training settings. Intervention(s): Educational intervention designed to increase knowledge and address negative attitudes and perceptions regarding EHS evaluation and treatment. Main Outcome Measure(s): Attitude and perception scores. Results: Prior to the educational intervention, most ATs (86.9%, 20/23) reported that they use methods other than rectal thermometry to evaluate EHS. Of those who did not use rectal thermometry, their reasons included: lack of equipment/budget, concerns about liability/lack of consent (especially when dealing with minors), lack of training, and/or concerns about the privacy, embarrassment, compliance of the athlete. Cold-water immersion was chosen as the definitive method of cooling an athlete by only 41.7% (n = 10) of participants. Following the educational intervention, attitudes toward the use of rectal temperature to assess core body temperature (t[24] = 8.663, P < .001) and cold-water immersion treatment for EHS (t[24] = 4.187, P < .001) were significantly improved. However, while attitudes toward the use of other “cold” methods to treat EHS were not significantly changed (t[24] = 1.684, P = .105), perceptions regarding nonexertional influences on EHS were significantly improved (t[24] = 1.684, P = .105). Conclusions: This study demonstrated that a 3-hour educational intervention can improve attitudes and perceptions regarding the assessment and treatment of EHS in the short term. It is important that educational interventions use best-practice continuing education methods and include special attention to the barriers to evidence-based practice.

Exertional heat stroke (EHS) is among the leading causes of sudden death during sport and physical activity. However, previous research has shown that EHS is 100% survivable when rapidly recognized and appropriate treatment is provided. Establishing policies to address issues related to the prevention and treatment of EHS, including heat acclimatization, environment-based activity modification, body temperature assessment using rectal thermometry, and immediate, onsite treatment using cold-water immersion attenuates the risk of EHS mortality and morbidity. This article provides an overview of the current evidence regarding EHS prevention and management. The transfer of scientific knowledge to clinical practice has shown great success for saving EHS patients. Further efforts are needed to implement evidence-based policies to not only mitigate EHS fatality but also to reduce the overall incidence of EHS.

Tokyo 2020 Summer Olympics are projected to experience environmental heat stress that surpasses the environmental conditions observed in the Atlanta (1996), Athens (2004), Beijing (2008), and Rio (2016) Summer Olympics. This raises particular concerns for athletes who will likely to be exposed to extreme heat during the competitions. Therefore, in mass-participation event during warm season, it is vital for the hosting organization to build preparedness and resilience against heat, including appropriate treatment, and management strategies for exertional heat stroke (EHS). However, despite the existing literature regarding the evidence-based management of EHS, rectal thermometry and whole-body cold-water immersion are not readily accepted by medical professionals outside of the sports, and military medicine professionals. Current Japanese medical standard is no exception in falling behind on evidence-based management of EHS. Therefore, the first aim of this paper is to elucidate the inconsistency between the standard of care provided in Japan for EHS and what has been accepted as the gold standard by the scientific literature. The second aim of this paper is to provide optimal EHS management strategies that should be implemented at the Tokyo 2020 Summer Olympics from organizational level to maximize the safety of athletes and to improve organizational resilience to heat. The risk of extreme heat is often neglected until a catastrophic incidence occurs. It is vital for the Japanese medical leadership and athletic communities to re-examine the current EHS management strategies and implement evidence-based countermeasure for EHS to expand the application of scientific knowledge.

Context:Evidence-based best practices for the recognition and treatment of exertional heat stroke (EHS) indicate that rectal thermometry and immediate, aggressive cooling via cold-water immersion ensure survival from this medical condition. However, little is known about the recovery, medical follow-up, and return to activity after an athlete has suffered EHS.Objective:To highlight the transfer of evidenced-based research into clinical practice by chronicling the treatment, recovery, and return to activity of a runner who suffered an EHS during a warm-weather road race.Design:Case study.Setting:Warm-weather road race.Participant:53-y-old recreationally active man.Intervention:A runner’s treatment, recovery, and return to activity from EHS and 2014 Falmouth Road Race performance.Main Outcomes:Runner’s perceptions and experiences with EHS, body temperature, heart rate, hydration status, exercise intensity.Results:The runner successfully completed the 2014 Falmouth Road Race without incident of EHS. Four dominant themes emerged from the data: predisposing factors, ideal treatment, lack of medical follow-up, and patient education. The first theme identified 3 predisposing factors that contributed to the runner’s EHS: hydration, sleep loss, and lack of heat acclimatization. The runner received ideal treatment using evidence-based best practices. A lack of long-term medical care following the EHS with no guidance on the runner’s return to full activity was observed. The runner knew very little about EHS before the 2013 race, which drove him to seek knowledge as to why he suffered EHS. Using this newly learned information, he successfully completed the 2014 Falmouth Road Race without incident.Conclusions:This case supports prior literature examining the factors that predispose individuals to EHS. Although evidence-based best practices regarding prompt recognition and treatment of EHS ensure survival, this case highlights the lack of medical follow-up and physician-guided return to activity after EHS.

Objectives Body temperature is commonly used for assessing health and identifying infectious diseases in cats. Rectal thermometry, the most commonly used method, is stressful, invasive and time consuming. Non-contact infrared thermometry (NIRT) has been used with mixed success to measure temperature in humans and other species. The purpose of this study was to determine if NIRT measurements were comparable to rectal temperature measurements or, if not highly correlated, could at least identify cats in the hypothermic or hyperthermic range in need of further evaluation. Methods From a total of six NIRT devices and 15 anatomic sites, three devices and three sites (pinna, gingiva and perineum) with the highest correlation to rectal temperature were selected for further study. Measurements were made in 188 adult cats housed indoors at animal shelters, veterinary clinics and private homes across a wide range of body temperatures and compared with rectal temperatures. Results Bland–Altman analysis revealed poor agreement between NIRT and rectal thermometry. The mean NIRT measurements ranged from 0.7–1.3°C below the mean rectal measurements, but the effect was not consistent; NIRT measurements tended to exceed rectal measurements in hypothermic cats and fall below rectal measurements in normothermic and hyperthermic cats. Conclusions and relevance The accuracy of temperature measurements using NIRT devices is not reliable for clinical use in cats.

Postmortem rectal temperature assessment is a gold standard examination for estimating time of death (TOD) in the early postmortem period. Postmortem computed tomography (PMCT) is frequently performed before autopsy. Two cases are presented where signs of rectal thermometry were found in PMCT. Rectal temperature measurement is a very important examination to perform at the scene of a death, and PMCT may ensure that the quality of this procedure is retained.

Exertional heat stroke, defined as a body temperature greater than 40°C to 40.5°C (104°F to 105°F) with associated central nervous system (CNS) dysfunction, is a medical emergency, and can lead to long-term complications or death without prompt recognition and proper care. Evidence shows that reducing body temperature below the critical threshold for cell damage (40.83°C) within 30 minutes of collapse ensures 100% survival without long-term sequelae.1–4 Evidence-based best practices clearly dictate that prompt assessment of body temperature using rectal thermometry and immediate, “cool first, transport second,” whole body cooling with cold water immersion is the standard of care for exertional heat stroke.5–7 However, what are clinicians to do if the gold-standard method of treatment, cold water immersion, is not feasible at the location where an exertional heat stroke occurs? The aim of this commentary is to provide clinicians with an alternative option for the treatment of exertional heat stroke in the event of cold water immersion not being available or feasible at a location where exertional heat stroke occurs.

Objective To evaluate the accuracy and associated induced stress response of axillary, auricular, and rectal thermometry in hospitalized dogs. Design Prospective observational study from October 2011 to February 2012. Setting University veterinary teaching hospital. Animals Two hundred fifty hospitalized dogs. All hospitalized dogs were considered eligible unless their condition precluded measurement at one of the designated sites. Interventions A veterinary auricular infrared device for auricular temperature (OT) and an electronic predictive thermometer for rectal temperature (RT) and axillary temperature (AT) were used for temperature measurements. All recordings were obtained by the same investigator in a randomized fashion. Heart rate was noted before and immediately after each measurement. Stress behaviors (eg, vocalization, lip licking, shaking, panting, defensive behavior) were also recorded and graded from 0 (lowest) to 4 (highest). Signalment, analgesic therapy, and length of hospitalization were recorded. Measurements and Main Results RT measurements were associated with greatest increase in heart rate (P < 0.05). Scores obtained for defensive behavior, lip licking, and vocalization were lowest with AT and highest with RT measurements (P < 0.05). Mean RT, AT, and OT were 38.0°C (SD: 0.85°C), 37.0°C (SD: 0.99°C), and 37.23°C (SD: 1.0382°C), respectively. AT and OT were moderately correlated with RT (r = 0.70 and r = 0.64, respectively). Gender (P = 0.02) and coat length (P = 0.03) had a significant influence on results. No effect of dehydration, body condition, analgesia, age, reproductive status, or operator experience was observed (P > 0.05). Conclusions AT and to a lesser extent OT are reliable, less stressful alternatives to estimate RT in dogs. Further studies are needed to evaluate these techniques in hyperthermic dogs, and to evaluate the use of AT and OT as monitoring tools in intensive care patients.

Objectives Fever is among the most common reasons for emergency department (ED) visits by children. This study compares temporal artery thermometry to rectal thermometry in febrile children in an ED. Methods This was a retrospective evaluation of children younger than 36 months treated consecutively in an urban medical center. Patients underwent triage with temporal artery thermometry, and after transfer to the pediatric ED, they underwent rectal thermometry. Fever was defined as rectal temperature of 100.4 °F (38 °C) or greater, and 147 patients met this definition. Data extraction from electronic charts obtained paired temporal artery and rectal temperatures, and these were compared by Bland-Altman analysis. Temperature points of 100.4 °F (38 °C) and 102.2 °F (39 °C) were evaluated to compare temporal artery thermometry with rectal thermometry sensitivity and specificity. Results A statistically and clinically significant difference between temporal artery and rectal temperature was found. Temporal artery thermometry was 53% sensitive detecting rectal temperature 100.4 °F (38 °C) or greater, and 27% sensitive detecting rectal temperature of 102.2 °F (39 °C) or greater. Mean rectal temperature was 102.36 °F (39.09 °C) (95% confidence interval [CI], 102.14 °F-102.58 °F); mean temporal artery temperature was 100.36°F (37.98 °C) (95% CI, 100.08 °F-100.65 °F), and mean difference between the two was 1.99 °F (1.11 °C) (95% CI, 1.75 °F-2.23 °F). Conclusions Temporal artery thermometry is poorly sensitive detecting fever and does not accurately reflect rectal temperature. Temporal artery thermometry should not be used for clinical management of children younger than 36 months if detection of fever is of importance.

Background Accurate measurement of temperature in the emergency room is important for diagnosis as well as investigating a patient. Various noninvasive methods thermometry are available today, but there is no consensus on the most accurate method of thermometry. Study objective The present study was conducted to compare different methods of temperature measurement available in the emergency room, that is, rectal, axillary, and temporal artery and tympanic membrane. Design This was a cross-sectional observational study Patients Fifty febrile and 50 afebrile children aged 2 to 12 years attending the pediatric emergency room of a tertiary care hospital were included. Temperatures were measured using rectal, axillary, tympanic (right and left), and temporal artery thermometers and were compared. Results All the temperatures correlated well with rectal temperature, with temporal artery temperature showing the best correlation (correlation coefficients, 0.99 in the febrile and 0.91 in the afebrile group). Conclusions Temporal artery thermometry has the potential to replace rectal thermometry in a busy emergency room setting.

Monitoring and measuring core body temperature is important to prevent or minimize physiological strain and cognitive dysfunction for workers such as first responders (e.g., firefighters) and military personnel. The purpose of this study is to compare estimated core body temperature (Tco-est), determined by heart rate (HR) data from a wearable chest strap physiology monitor, to standard rectal thermometry (Tre) under different conditions. Tco-est and Tre measurements were obtained in thermoneutral and heat stress conditions (high temperature and relative humidity) during four different experiments including treadmill exercise, cycling exercise, passive heat stress, and treadmill exercise while wearing personal protective equipment (PPE). Overall, the mean Tco-est did not differ significantly from Tre across the four conditions. During exercise at low-moderate work rates under heat stress conditions, Tco-est was consistently higher than Tre at all-time points. Tco-est underestimated temperature compared to Tre at rest in heat stress conditions and at a low work rate under heat stress while wearing PPE. The mean differences between the two measurements ranged from -0.1 ± 0.4 to 0.3 ± 0.4°C and Tco-est correlated well with HR (r = 0.795 - 0.849) and mean body temperature (r = 0.637 - 0.861). These results indicate that, the comparison of Tco-est to Tre may result in over- or underestimation which could possibly lead to heat-related illness during monitoring in certain conditions. Modifications to the current algorithm should be considered to address such issues.

Measurement of body temperature is a routine part of the clinical assessment of a patient. However, this procedure may be time-consuming and stressful to most animals because the standard site of temperature acquisition remains the rectal mucosa. Although an increasing number of clinicians have been using auricular temperature to estimate core body temperature, evidence is still lacking regarding agreement between these two methods in cats. In this investigation, we evaluated the agreement between temperatures measured in the rectum and ear in 29 healthy cats over a 2-week period. Temperatures were measured in the rectum (using digital and mercury-in-glass thermometers) and ear once a day for 14 consecutive days, producing 406 temperature readings for each thermometer. Mean temperature and confidence intervals were similar between methods, and Bland–Altman plots showed small biases and narrow limits of agreement acceptable for clinical purposes. The interobserver variability was also checked, which indicated a strong correlation between two near-simultaneous temperature readings. Results are consistent with auricular thermometry being a reliable alternative to rectal thermometry for assessing core body temperature in healthy cats.

Accurate measurement of temperature is important for detection of fever and hypothermia in pediatric patients. Ideal temperature-measurement technique should be safe, easy, noninvasive, cost effective, time efficient, and should precisely reflect core body temperature. Pulmonary artery is the closest to hypothalamus and best reflects the core temperature. Other sites used are distal esophagus, urinary bladder and nasopharynx. All these methods are invasive and difficult to use in clinical practice. Amongst the noninvasive methods, rectal thermometry is considered to be the closest to core temperature, but it has its own drawbacks. With the current evidence available, tympanic artery thermometry for children more than 2 years of age and temporal artery thermometry in all age groups are taking precedence over other methods.

To assess the efficacy of temporal artery thermometer in febrile and hypothermic neonates in comparison to axillary thermometer. It was a cross sectional observational study. Study participants included 210 neonates admitted in neonatal intensive care unit of a tertiary care teaching hospital, divided into three groups of 70 each, namely normothermic, febrile and hypothermic. Temperatures were measured using temporal artery, axillary and rectal thermometers in each patient. Mean rectal temperature was found to be comparable to mean temporal artery temperature in normothermic babies. Temporal artery thermometer had a better sensitivity to diagnose fever, than hypothermia. Also, temporal artery temperature showed a good correlation with rectal temperature in normothermic and febrile group and not in hypothermic neonates. Temporal artery thermometer can accurately detect temperature in febrile and normothermic fullterm neonates but not in hypothermic neonates. Further studies are required before advocating temporal artery thermometry as a replacement of rectal thermometry among this group of population.

Context: Athletic trainers (ATs) know to diagnose exertional heat stroke (EHS) via rectal thermometry (Tre) and to treat EHS via cold-water immersion (CWI) but do not implement these recommendations in clinical practice. Objective: To gain an understanding of educational techniques used to deliver content regarding EHS. Design: Qualitative study. Setting: In-person focus groups at the National Athletic Trainers' Association (NATA) Annual Meeting in June 2009 and 2 follow-up telephone interviews to confirm emergent themes. Patients or Other Participants: Thirteen AT educators (11 men, 2 women) from programs accredited by the Commission on Accreditation of Athletic Training Education, with an average of 22 ± 9 years of clinical experience and 16 ± 10 years of experience as educators. Five NATA districts were represented. Data Collection and Analysis: Data were analyzed using inductive content analysis. Peer review and data source triangulation also were conducted to establish trustworthiness. Results: Four themes emerged from the analysis: educational techniques, educational competencies, previous educational training, and privacy/public opinion. Educational techniques highlighted the lack of hands-on training for Tre and CWI. Educational competencies referred to the omission of Tre and CWI as psychomotor skills. Previous educational training addressed educators not having the skills or comfort with the skills necessary to properly educate students. Privacy/public opinion comprised external inputs from various groups (parents and coaches), legal considerations, and social bias. Conclusions: Educators supplied students with the appropriate didactic knowledge about EHS, but their lack of training and misgivings about Tre prevented them from allowing students to gain competence with this skill. Until the NATA competencies state the need to teach Tre and CWI and until educators are provided with their own learning opportunities, evidence-based practice regarding EHS will be lacking.

Background: Rectal thermometry is considered the most reliable method for measuring the temperature in the paediatric population. Recently, a new non-contact skin infrared thermometer for children was introduced in the market with excellent acceptance by parents. Methods: A prospective, analytical, cross-sectional study was designed in order to assess the effectiveness of the infrared non-contact thermometer (Thermofocus) in comparison with two other known methods used to measure body temperature. Children aged 1 to 48 months were included from the emergency room and inpatient unit. All patients selected were assessed with three different thermometers: (1) non-contact infrared thermometer (Thermofocus); (2) temporal artery thermometer (Exergen); and (3) rectal glass mercury thermometer. Results: Four hundred and thirty-four patients were eligible to complete the study. One hundred and sixty-seven were identified with fever. The mean age of the patients studied was 14.6 ± 10.7 months. Both devices were strongly correlated with the rectal temperature: r = 0.950 for Exergen and r = 0.952 for Thermofocus. The mean difference in temperature between the rectal temperature and the non-contact thermometer was 0.029 ± 0.01 °C (P < 0.001), while the mean difference between the temporal artery thermometer and the rectal temperature was -0.20 ± 0.27 °C (P < 0.001). The sensitivity and specificity for the non-contact thermometer is 97%. The negative predictive value is 99%, which is especially important to rule out fever and avoid unnecessary laboratory work-up. Conclusions: The non-contact infrared thermometer is a reliable, comfortable and accurate option for measurement of temperature and is very useful for the screening of fever in the paediatric population. More studies are recommended to support the evidence found in this study and compare its accuracy with more complex devices.

Background Measuring core body temperature in a manner that is safe for animals and veterinary personnel is an important part of a physical examination. For nonhuman primates, this can involve increased restraint, additional stress, as well as the use of anesthetics and their deleterious effects on body temperature measurements. The purpose of this study was to compare two non-invasive methods of infrared tympanic thermometry to standard rectal thermometry in adult squirrel monkeys. Methods Tympanic temperatures were collected from 37 squirrel monkeys and compared to rectal temperatures using a human and veterinary infrared tympanic thermometer. Results Compared with rectal temperature measurements, the human tympanic thermometer readings were not significantly different, while the veterinary tympanic thermometer measurements were significantly higher (P

Gnotobiotic piglets (n = 10) were hand-reared in conventional germ-free facilities. Piglet body temperatures were measured with rectal and non-contact infrared thermometry (NIFT) on the lower eyelid, auricular center and margin, parietal regions, axilla, central abdomen and dorsum, and the perianal region. Body temperature measurements at central abdomen, cranial dorsum, and perianal regions had NIFT values which had a significant linear relationship (p