Reliability of body temperature measurements in hospitalised older patients

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Abstract

Aims and objectives

To compare different body temperature assessment methods in older people and to assess the role of cognitive and functional characteristics in temperature recordings.

Background

Axillary gallium-in-glass thermometers are commonly used. Their accuracy depends on the proper placement of the device and their permanence in place for eight minutes. With adequate instruction, well-functioning patients can measure their axillary temperature by themselves, while in cognitively and functionally impaired older people, inadequate understanding of instructions and misplacement of the thermometer might determine significant recording errors. Electronic ear and axillary temperature measurements are faster, but their accuracy has not been demonstrated convincingly with older people.

Methods

Patients (n = 107; aged 65–104 years) were recruited. Barthel Index and Short Portable Mental Status Questionnaire (SPMSQ) scores were obtained for each patient. Temperature readings were obtained using: the axillary gallium-in-glass thermometer, with (Tnurse) and without (Tself) the nurse's assistance; the electronic axillary thermometer (Tel) and the infrared tympanic thermometer (Ttymp). The Tnurse was considered as the reference method.

Results

Mean difference and standard deviation (mean ± SD) in temperature recordings between the different techniques and Tnurse differed significantly from zero for Tself (−0·40 SD 0·42) and Ttymp (+0·19 SD 0·48). No significant differences in temperature recordings emerged between Tnurse and Tel. In simple linear regression models, the difference between Tself and Tnurse significantly correlated with age, gender, SPMSQ score and Barthel Index. Multiple linear regression analysis showed an underestimation of body temperature in older patients with cognitive impairments.

Conclusion

Unassisted gallium-in-glass axillary temperature assessment is inadequate, in older patients. The differences between Tself and Tnurse are significantly influenced by age and mental decline. Tel provides adequate accuracy.

Relevance to clinical practice

In geriatric settings, the electronic axillary thermometer is a safe and accurate alternative to the more traditional gallium-in-glass thermometer, with the advantage of saving time (five seconds in recording vs. eight minutes).

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