Body temperature measurement in paediatrics: Which gadget should we believe?
Notice bibliographique
Résumé
any decisions regarding the investigation and treatmentof paediatric patients are determined by body temper-ature. In the 21st century, we still struggle to find a quickand convenient method that parents and health care workerscan use to measure body temperature accurately.The goal of measuring body temperature is to approxi-mate the core temperature, which is the temperature of theblood that bathes the temperature-regulating centre in thehypothalamus. However, there is a gradient between everybody site where temperature can be measured and the hypo-thalamus. Contrary to popular dogma, this gradient is notconstant (ie, rectal temperature is not reliably 1°C higherthan axillary temperature). Therefore, it is difficult tochoose a body site to use as the reference standard for com-paring readings obtained by different instruments or at dif-ferent sites.The following sites have been used in studies of bodytemperature measurement in children:• Pulmonary artery (PA):This site is vascular, and it isanatomically relatively close to the hypothalamus. Inadults, PA readings are only 0.18°C lower thanreadings from blood returning from the brain in thehigh internal jugular vein (1). PA catheters are usuallyonly placed in children during cardiac surgery, but thisremains the best site to use as the reference standardfor core temperature in studies comparingmeasurements taken from other body sites and withdifferent instruments.• Distal esophagus:This site is easily accessible insedated patients, and readings in paediatric patients arecloser to PA readings than are rectal, axillary, bladderor tympanic readings (2). Therefore, this site is a goodchoice for temperature measurement in sedatedpatients or for use as a reference standard when PA readings are not practical. • Rectal: Although used as the reference standard inmany previous studies, the rectum is a long distancefrom the hypothalamus. Decreased splanchnic flow canresult in falsely low readings and rectal temperature isslow to respond to changes in core temperature,especially if stool is present in the lower rectum (2,3).There is often reluctance on the part of parents andolder children to measure rectal temperature, andnosocomial infections have been attributed to the useof rectal thermometers in hospital (4). There are rarecase reports of rectal perforation caused by rectalthermometers in neonates and the safety of doingrectal temperatures in neutropenic patients has notbeen established. • Bladder: Urinary catheters with thermistors areavailable, but the results of studies are disparate as towhether bladder temperatures are closer to PA readingsthan rectal temperatures (2,5). Readings may be falselylow if urine output is decreased.• Nasopharyngeal: In the only paediatric study (5) todate that compared nasopharyngeal temperature withother sites, mean difference from PA temperature was0.43°C, which was higher than the difference forbladder temperatures, but lower than the difference forrectal, tympanic or axillary temperatures. Induction ofnasopharyngeal bleeding is a potential risk. • Axillary: To obtain an accurate reading, thethermometer probe must be placed over the axillaryartery, which is a great challenge in children. Localcooling (‘drawdown’) can occur from placement of thethermometer in a neonate (6). Axillary readings areexpected to be lower than readings from other sites,and this appears to be the case with all types ofthermometers (7). For all these reasons, fever is oftennot detected by axillary readings.• Tympanic: Tympanic temperatures were initiallymeasured with a probe applied directly to the tympanicmembrane and were found to closely approximate thetemperature in the circle of Willis (8). Infraredthermometers were then developed, and readings canbe obtained within a few seconds by blindly directingthe tip of the instrument toward the tympanicmembrane. Readings are not affected by cerumin or
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Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,003 | 0,001 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,001 | 0,000 |
| Bibliométrie | 0,001 | 0,003 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,002 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,000 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule tête enseignante, pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».