Accuracy, Precision, and Validity of Fever Detection using Non-invasive Temperature Measurement in Adult Coronary Care Unit Patients with Pulmonary Catheters

PURPOSE: To investigate the accuracy, precision and validity of fever detection of tympanic membrane (TM), temporal artery (TA) and axillary temperature (AT) compared with pulmonary artery temperature (PA). METHODS: Repeated-measures design was conducted for one year on 83 adult cardiac care unit patients with pulmonary artery catheters after open heart surgery. Sequential temperature measurements were taken three times at 20-minute intervals. Accuracy, precision, repeatability, and validity of fever detection were analyzed. RESULTS: Mean pulmonary artery temperature was 37.04degrees C (SD 0.70degrees C). The mean (SD) offsets from PA, with the mean reflecting accuracy and SD reflecting precision, were -1.31degrees C (0.75degrees C) for TA, -0.20degrees C (0.24degrees C) for TM, and -0.97degrees C (0.64degrees C) for AT. Percentage of pairs with differences within +/-0.5degrees C was 9.6% for TA, 19.7% for AT, and 91.6% for TM. Repeated measurements with all three methods had mean SD values within 0.04degrees C. Sensitivity, specificity, and positive and negative predictive values of tympanic measurements were 0.76, 1.0, and 1.0, and 0.90, respectively. CONCLUSION: Results show that TM best reflects PA, and is most consistent, accurate, and precise. AT tends to underestimate PA, and TA is least accurate and precise. Therefore tympanic membrane measurement is a reliable alternative to other non-invasive methods of measuring temperatures.

Gluteal Subcutaneous Fat Thickness Measured by Computed Tomography as an Estimate of Proper Gluteal Intramuscular Injections in Korean Adults

PURPOSE: To study the thickness of gluteal subcutaneous fat (SCF) and propose an adequate length for needle for gluteal intramuscular injections based on computed tomography (CT) measurements. METHODS: The thickness of gluteal SCF were measured and studied for 568 patients who visited a tertiary hospital in Seoul, Korea between January 2007 and February 2009 for routine health screening and who had abdominopelvic CT. RESULTS: The average thickness of gluteal SCF was 15.92+/-4.08 mm in males and 24.90+/-5.47 mm in females. The thickness of gluteal SCF differed significantly according to gender. The gluteal SCF thickness was greater than 20.4 mm for 54 (12.3%) of the 440 male patients and 99 (77.3%) of the 128 female patients. CONCLUSION: The most common syringe needle used for gluteal intramuscular injections in Korea is a 23 G, 25.4 mm-needle. The SCF thickness must be less than 20.4 mm in order to reach the dorsogluteal muscles to a depth of at least 5 mm if this 25.4 mm needle is used. In many patients, especially in female patients, the 25.4 mm needles will result in improper intramuscular injections with the injection being into the SCF. Therefore an appropriate needle should be selected by considering the gender and SCF thickness of patients receiving gluteal intramuscular injections.