UCSF

Introduction: Detection of fever in geriatric patients in the emergency department (ED) is a critical assessment parameter. However, immune responses become less robust with increasing age. Therefore, it is important to determine if a new method for measuring temperature (i.e., temporal artery thermometer [TAT]) is as accurate as rectal thermometer (RT) in older patients. The purposes of this study were to: compare agreement between RT and TAT readings in younger (i.e., 65-74 years of age, n=50) versus older (i.e., ≥75 years of age, n=75) geriatric patients seen in the ED and compare the sensitivity and specificity of the TAT to detect fever between these two groups.

Methods: A convenience sample of patients ≥65 years of age had TAT and RT taken on arrival to the ED. Descriptive statistics were calculated; Fisher’s Exact and Mann-Whitney U tests were used to evaluate for gender differences and ESI distributions between the groups. Analysis of variance was used to evaluate the effect of age group on TAT and RT differences. Logistic regression was used to determine sensitivity and specificity of TAT.

Results: The two groups were 69.5 (3.6) and 82.7 (5.8) years of age. No statistically significant differences were found in mean RT and mean TAT measurements between the younger and older geriatric patients. Sensitivity to detect fever was 53.8% in the younger group and 50.0% in the older group, and specificities were 95.8% and 95.3%, respectively.

Discussion: TAT yields a false negative rate that is too high to be used to evaluate for fever in geriatric patients in the ED. TAT’s low sensitivity suggests that RT needs to remain the primary method of temperature assessment in geriatric patients who cannot provide reliable oral temperatures.