红外温度测试仪中英文翻译.docx

红外温度测试仪中英文翻译.docx

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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：

EmergInfectDis.2008August;14（8）:

1255–1258.

doi:

10.3201/eid1408.080059

PMCID:

PMC2600390

CutaneousInfraredThermometryforDetectingFebrilePatients

PierreHausfater,YanZhao,StéphanieDefrenne,PascaleBonnet,andBrunoRiou*

AuthorinformationCopyrightandLicenseinformation

ThisarticlehasbeencitedbyotherarticlesinPMC.

Abstract

Weassessedtheaccuracyofcutaneousinfraredthermometry,whichmeasurestemperatureontheforehead,fordetectingpatientswithfeverinpatientsadmittedtoanemergencydepartment.Althoughnegativepredictivevaluewasexcellent（0.99）,positivepredictivevaluewaslow（0.10）.Therefore,wequestionmassdetectionoffebrilepatientsbyusingthismethod.

Keywords:

Fever,massdetection,cutaneousinfraredthermometry,infectiousdiseases,emergency,dispatch

Recenteffortstocontrolspreadofepidemicinfectiousdiseaseshavepromptedhealthofficialstodeveloprapidscreeningprocessestodetectfebrilepatients.Suchscreeningmaytakeplaceathospitalentry,mainlyintheemergencydepartment,oratairportstodetecttravelerswithincreasedbodytemperatures（1–3）.Infraredthermalimagingdeviceshavebeenproposedasanoncontactandnoninvasivemethodfordetectingfever（4–6）.However,fewstudieshaveassessedtheircapacityforaccuratedetectionoffebrilepatientsinclinicalsettings.Therefore,weundertookaprospectivestudyinanemergencydepartmenttoassessdiagnosticaccuracyofinfraredthermalimaging.

TheStudy

Thestudywasperformedinanemergencydepartmentofalargeacademichospital（1,800beds）andwasreviewedandapprovedbyourinstitutionalreviewboard（ComitédeProtectiondesPersonnessePrêtantàlaRechercheBiomédicalePitié-Salpêtrière,Paris,France）.Patientsadmittedtotheemergencydepartmentwereassessedbyatrainedtriagenurse,andseveralvariableswereroutinelymeasured,includingtympanictemperaturebyusinganinfraredtympanicthermometer（Pro4000;WelchAllyn,SkaneatelesFalls,NY,USA）,systolicanddiastolicarterialbloodpressure,andheartrate.

Tympanictemperaturewasmeasuredtwice（onceintheleftearandonceintherightear）.Thistemperaturewasusedasareferencebecauseitisroutinelyusedinouremergencydepartmentandisanappropriateestimateofcentralcoretemperature（7–9）.Cutaneoustemperaturewasmeasuredontheforeheadbyusinganinfraredthermometer（RayngerMX;Raytek,Berlin,Germany）（Figure1）.Rationaleforaninfraredthermometerdeviceinsteadofalargerthermalscannerwasthatwewantedtotestamethod（i.e.,measurementofforeheadcutaneoustemperaturebyusingasimpleinfraredthermometer）andnotaspecificdevice.Theforeheadregionwaschosenbecauseitismorereliablethantheregionbehindtheeyes（5,10）.Thelatterregionmaynotbeappropriateformassscreeningbecauseonecannotaccuratelymeasuretemperaturethrougheyeglasses,whicharewornbymanypersons.Outdoorandindoortemperatureswerealsorecorded.

Figure1

Measurementofcutaneoustemperaturewithaninfraredthermometer.A）Thedeviceisplaced20cmfromtheforehead.B）Assoonastheexaminerpullsthetrigger,thetemperaturemeasuredisshownonthedisplay.Usedwithpermission.

Themainobjectiveofourstudywastoassessdiagnosticaccuracyofinfraredthermometryfordetectingpatientswithfever,definedasatympanictemperature>38.0°C.Thesecondobjectivewastocomparemeasurementsofcutaneoustemperatureandtympanictemperature,withthelatterbeingusedasareferencepoint.Dataareexpressedasmean±standarddeviation（SD）orpercentagesandtheir95%confidenceintervals（CIs）.Comparisonof2meanswasperformedbyusingtheStudentttest,andcomparisonof2proportionswasperformedbyusingtheFisherexactmethod.Bias,precision（inabsolutevaluesandpercentages）,andnumberofoutliers（definedasadifference>1°C）werealsorecorded.Correlationbetween2variableswasassessedbyusingtheleastsquaremethod.TheBlandandAltmanmethodwasusedtocompare2setsofmeasurements,andthelimitofagreementwasdefinedas±2SDsofthedifferences（11）.Wedeterminedthereceiveroperatingcharacteristic（ROC）curvesandcalculatedtheareaundertheROCcurveandits95%CI.TheROCcurvewasusedtodeterminethebestthresholdforthedefinitionofhyperthermiaforcutaneoustemperaturetopredictatympanictemperature>38°C.Weperformedmultivariateregressionanalysistoassessvariablesassociatedwiththedifferencebetweentympanicandinfraredmeasurements.Allstatisticaltestswere2-sided,andapvalue<0.05wasrequiredtorejectthenullhypothesis.StatisticalanalysiswasperformedbyusingNumberCruncherStatisticalSystems2001software（StatisticalSolutionsLtd.,Cork,Ireland）.

Atotalof2,026patientswereenrolledinthestudy:

1,146（57%）menand880（43%）women46±19yearsofage（range6–103years）;219（11%）were>75yearsofage,and62（3%）hadatympanictemperature>38°C.Meantympanictemperaturewas36.7°C±0.6°C（range33.7°C–40.2°C）,andmeancutaneoustemperaturewas36.7°C±1.7°C（range32.0°C–42.6°C）.Meansystolicarterialbloodpressurewas130±19mmHg,meandiastolicbloodpressurewas79±13mmHg,andmeanheartratewas86±17beats/min.Meanindoortemperaturewas24.8°C±1.1°C（range20°C–28°C）,andmeanoutdoortemperaturewas10.8°C±6.8°C（range0°C–32°C）.Reproducibilityofinfraredmeasurementswasassessedin256patients.Biaswas0.04°C±0.35°C,precisionwas0.22°C±0.27°C（i.e.,0.6±0.7%）,andpercentageofoutliers>1°Cwas2.3%.

DiagnosticperformanceofcutaneoustemperaturemeasurementisshowninTable1.Forthethresholdofthedefinitionoftympanichyperthermiadefinitionused（37.5°C,38°C,or38.5°C）,sensitivityofcutaneoustemperaturewaslowerthanthatexpectedandpositivepredictivevaluewaslow.Weattemptedtodeterminethebestthreshold（definitionofhyperthermia）byusingcutaneoustemperaturetopredictatympanictemperature>38°C（Figure2,panelA）.AreaundertheROCcurvewas0.873（95%CI0.807–0.917,p<0.001）.Thebestthresholdforcutaneoushyperthermiadefinitionwas38.0°C,aconditionalreadyassessedinTable1.Figure2,panelsBandCshowsthecorrelationbetweencutaneousandtympanictemperaturemeasurements（BlandandAltmandiagrams）.Correlationbetweencutaneousandtympanicmeasurementswaspoor,andtheinfraredthermometerunderestimatedbodytemperatureatlowvaluesandoverestimateditathighvalues.Multipleregressionanalysisshowedthat3variables（tympanictemperature,outdoortemperature,andage）weresignificantly（p<0.001）andindependentlycorrelatedwiththemagnitudeofthedifferencebetweencutaneousandtympanicmeasurements（Table2）.

Table1

Assessmentofdiagnosticperformanceofcutaneoustemperatureinpredictingincreasedtympanictemperature*

Figure2

A）Comparisonofreceiveroperatingcharacteristic（ROC）curvesshowingrelationshipbetweensensitivity（truepositive）and1–specificity（truenegative）indeterminingvalueofcutaneoustemperatureforpredictingvariousthresholdsofhyperthermia...

Table2

Variablescorrelatedwithmagnitudeofthedifferencebetweencutaneousandtympanictemperaturemeasurements*

Conclusions

Infraredthermometrydoesnotreliablydetectfebrilepatientsbecauseitssensitivitywaslowerthanthatexpectedandthepositivepredictivevaluewaslow,whichindicatedahighproportionoffalse-positiveresults.Ngetal.（5）studied502patients,concludedthataninfraredthermalimagercanappropriatelyidentifyfebrilepatients,andreportedahighareaundertheROCcurvevalue（0.972）,whichissimilartotheareawefoundinthepresentstudy（0.925）.However,suchglobalassessmentisoflimitedvaluebecauseoflowincidenceoffeverinthepopulation.Ratherthanlookingatpositivepredictivevalueoraccuracy,oneshoulddeterminenegativepredictivevalue.Thisdeterminationmightbeofgreaterconsequenceifoneconsidersanairtravelerpopulationorapopulationenteringahospital.

Ngetal.（5）identifiedoutdoortemperatureasaconfoundingvariableincutaneoustemperaturemeasurement.Ourstudyidentifiedageasavariablethatinterfereswithcutaneousmeasurement,buttheroleofgenderislessobvious.Olderpersonsshowedimpaireddefense（stability）ofcoretemperaturesduringcoldandheatstresses,andtheircutaneousvascularreactivitywasreduced（12,13）.

Useofasimpleinfraredthermometry,ratherthansophisticatedimaging,shouldnotbeconsideredalimitationbecausethismethodconcernstherelationshipbetweencutaneousandcentralcoretemperatures.Wecanextrapolateourresultstoanydevicesthatestimatecutaneoustemperatureandthesoftwareusedtoaverageit.Ourstudyattemptedtodetectfebrilepatients,notinfectedpatients.Formassdetectionofinfection,focusingonfevermeansthatnonfebrilepatientsarenotdetected.Thislastpointisusefulbecausefeverisnotaconstantphenomenonduringaninfectiousdisease,antipyreticdrugsmayhavebeentakenbypatients,andahypothermicratherthanhyperthermicreactionmayoccurduringaninfectiousprocess.

Inconclusion,weobservedthatcutaneoustemperaturemeasurementbyusinginfraredthermometrydoesnotprovideareliablebasisforscreeningoutpatientswhoarefebrilebecausethegradientbetweencutaneousandcoretemperaturesismarkedlyinfluencedbypatient’sageandenvironmentalcharacteristics.Massdetectionoffebrilepatientsbyusingthistechniquecannotbeenvisagedwithoutacceptingahighrateoffalse-positiveresults.

Acknowledgment

WethankDavidBakerforreviewingthemanuscript.ThisstudywassupportedbytheDirectionGénéraledela