The effects of measurement site and ambient temperature on body temperature values in healthy older adults: a cross-sectional comparative study

Abstract

Background: Accurate baseline body temperature measurement is essential for assessment. Tympanic membrane temperature (TMT) measurement is popular, but there is no consensus on whether it is as accurate as oral temperature (OT) for use with the elderly at varying ambient temperature levels.

Objectives: To test agreement between TMT and OT measurement of body temperature among an elderly population; and to explore whether agreement between the two sites depends on ambient temperature.

Design: A cross-sectional comparison study.

Methods: Two samples of older community-dwelling adults were recruited from 17 community senior citizen centers in Taipei, Taiwan in winter (n=262) and summer (n=257) of 2007. TMT and OT were simultaneously measured by electronic infrared ear thermometer and electronic digital thermometer. Ambient temperatures measured by digital thermo-hygrometer of the data collection setting were recorded when body temperature was taken.

Results: In winter mean TMT was 36.64 degrees C (S.D. 0.37), and mean OT was 36.74 degrees C (S.D. 0.18). In summer, the mean TMT was 37.05 degrees C (S.D. 0.30) and mean OT was 36.85 degrees C (S.D. 0.22). The relationship between TMT and OT were r=0.42 (p<0.001) in winter and r=0.57 (p<0.001) in summer. The values of OT were used as standard to assess the accuracy of the measurement. The bias between TMT and OT was -0.10 degrees C (S.D. 0.34) and 95% limits of agreement were 0.57 and -0.77 degrees C in winter; and bias was 0.20 degrees C (S.D. 0.25) and 95% limits of agreement were 0.69 and -0.29 degrees C in summer. The findings of this study demonstrate that the TMT has high variability that may under or over estimate body temperatures.

Conclusions: There is a lack of agreement in body temperatures values between TMT and OT in community-dwelling elderly in both winter and summer. OT was more stable than TMT regardless of ambient temperature influences. Therefore, the oral cavity is preferable to the TM site for temperature measurement in alert elderly. The limitation of this study is that hospitalized patients who are most likely to need temperature measurement are not included in this study.