红外温度测试仪中英文翻译(共10页).doc

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1、精选优质文档-倾情为你奉上附录一：英文技术资料翻译英文原文：Emerg Infect Dis. 2008 August; 14(8): 12551258.doi: 10.3201/eid1408.PMCID: PMCCutaneous Infrared Thermometry for Detecting Febrile Patients, , , , and * This article has been other articles in PMC.AbstractWe assessed the accuracy of cutaneous infrared thermometry, which

2、 measures temperature on the forehead, for detecting patients with fever in patients admitted to an emergency department. Although negative predictive value was excellent (0.99), positive predictive value was low (0.10). Therefore, we question mass detection of febrile patients by using this method.

3、Keywords: Fever, mass detection, cutaneous infrared thermometry, infectious diseases, emergency, dispatchRecent efforts to control spread of epidemic infectious diseases have prompted health officials to develop rapid screening processes to detect febrile patients. Such screening may take place at h

4、ospital entry, mainly in the emergency department, or at airports to detect travelers with increased body temperatures (). Infrared thermal imaging devices have been proposed as a noncontact and noninvasive method for detecting fever (). However, few studies have assessed their capacity for accurate

5、 detection of febrile patients in clinical settings. Therefore, we undertook a prospective study in an emergency department to assess diagnostic accuracy of infrared thermal imaging.The StudyThe study was performed in an emergency department of a large academic hospital (1,800 beds) and was reviewed

6、 and approved by our institutional review board (Comit de Protection des Personnes se Prtant la Recherche Biomdicale Piti-Salptrire, Paris, France). Patients admitted to the emergency department were assessed by a trained triage nurse, and several variables were routinely measured, including tympani

7、c temperature by using an infrared tympanic thermometer (Pro 4000; Welch Allyn, Skaneateles Falls, NY, USA), systolic and diastolic arterial blood pressure, and heart rate.Tympanic temperature was measured twice (once in the left ear and once in the right ear). This temperature was used as a referen

8、ce because it is routinely used in our emergency department and is an appropriate estimate of central core temperature (). Cutaneous temperature was measured on the forehead by using an infrared thermometer (Raynger MX; Raytek, Berlin, Germany) (). Rationale for an infrared thermometer device instea

9、d of a larger thermal scanner was that we wanted to test a method (i.e., measurement of forehead cutaneous temperature by using a simple infrared thermometer) and not a specific device. The forehead region was chosen because it is more reliable than the region behind the eyes (,). The latter region

10、may not be appropriate for mass screening because one cannot accurately measure temperature through eyeglasses, which are worn by many persons. Outdoor and indoor temperatures were also recorded.Measurement of cutaneous temperature with an infrared thermometer. A) The device is placed 20 cm from the

11、 forehead. B) As soon as the examiner pulls the trigger, the temperature measured is shown on the display. Used with permission.The main objective of our study was to assess diagnostic accuracy of infrared thermometry for detecting patients with fever, defined as a tympanic temperature 38.0C. The se

12、cond objective was to compare measurements of cutaneous temperature and tympanic temperature, with the latter being used as a reference point. Data are expressed as mean standard deviation (SD) or percentages and their 95% confidence intervals (CIs). Comparison of 2 means was performed by using the

13、Student t test, and comparison of 2 proportions was performed by using the Fisher exact method. Bias, precision (in absolute values and percentages), and number of outliers (defined as a difference 1C) were also recorded. Correlation between 2 variables was assessed by using the least square method.

14、 The Bland and Altman method was used to compare 2 sets of measurements, and the limit of agreement was defined as 2 SDs of the differences (). We determined the receiver operating characteristic (ROC) curves and calculated the area under the ROC curve and its 95% CI. The ROC curve was used to deter

15、mine the best threshold for the definition of hyperthermia for cutaneous temperature to predict a tympanic temperature 38C. We performed multivariate regression analysis to assess variables associated with the difference between tympanic and infrared measurements. All statistical tests were 2-sided,

16、 and a p value 75 years of age, and 62 (3%) had a tympanic temperature 38C. Mean tympanic temperature was 36.7C 0.6C (range 33.7C40.2C), and mean cutaneous temperature was 36.7C 1.7C (range 32.0C42.6C). Mean systolic arterial blood pressure was 130 19 mm Hg, mean diastolic blood pressure was 79 13 m

17、m Hg, and mean heart rate was 86 17 beats/min. Mean indoor temperature was 24.8C 1.1C (range 20C28C), and mean outdoor temperature was 10.8C 6.8C (range 0C32C). Reproducibility of infrared measurements was assessed in 256 patients. Bias was 0.04C 0.35C, precision was 0.22C 0.27C (i.e., 0.6 0.7%), an

18、d percentage of outliers 1C was 2.3%.Diagnostic performance of cutaneous temperature measurement is shown in . For the threshold of the definition of tympanic hyperthermia definition used (37.5C, 38C, or 38.5C), sensitivity of cutaneous temperature was lower than that expected and positive predictiv

19、e value was low. We attempted to determine the best threshold (definition of hyperthermia) by using cutaneous temperature to predict a tympanic temperature 38C (, panel A). Area under the ROC curve was 0.873 (95% CI 0.8070.917, p0.001). The best threshold for cutaneous hyperthermia definition was 38

20、.0C, a condition already assessed in . , panels B and C shows the correlation between cutaneous and tympanic temperature measurements (Bland and Altman diagrams). Correlation between cutaneous and tympanic measurements was poor, and the infrared thermometer underestimated body temperature at low val

21、ues and overestimated it at high values. Multiple regression analysis showed that 3 variables (tympanic temperature, outdoor temperature, and age) were significantly (p 38C.第二个目的是比较皮肤温度和鼓膜温度的测量，后者被用来作为一个参考点。数据表示的意思标准偏差（SD）或百分比和95%可信区间（CIs）。 采用t检验和Fisher确切概率法对2种方法进行比较。偏置，精度（绝对值和百分比）被记录下来， 异常值的数量（定义为差

22、1C）也会被记录下来。2个变量之间的相关性，利用最小二乘法进行评估。Bland和奥特曼方法是用来比较2组测量值，协议的限制定义为2 SDS的差异（11 ）。我们确定接收器工作特性（ROC）曲线，然后计算ROC曲线下的面积和它的调用计时器的95%的值。ROC曲线被用来确定皮肤温度的最佳阈值，它的热疗定义的预测鼓膜温度 38C。我们进行了多元回归分析来评估鼓膜温度和实际红外测量值之间的差异。 所有的统计检验都有双面性，P值0.05则没有零假设。统计分析是通过数字计算机系统2001软件进行统计（统计解决方案公司，科克，爱尔兰）。共有2026例患者参加了这项研究：1146位（57%）男性和880位女性

23、（43%）年龄为4619岁（范围6103年）；219位（11%）年龄75岁，62（3%）位鼓膜温度 38C.意味着鼓膜温度为36.7 C 0.6C（33.7C40.2C），平均皮肤温度为36.7C1.7C（32C42.6C）。平均收缩压为13019 mm Hg，平均舒张压为7913毫米汞柱，平均心率为8617次/分。也意味着室内平均温度为24.8C1.1C（20C28C），室外平均温度为10.8C6.8C（0C32C）。红外测量的可重复性在256例患者中进行了评估。偏见为0.04C0.35C，精度为0.22C0.27C（即0.60.7%），这其中异常值1C的比例为2.3%。 皮肤温度测量诊断性

24、能如表1所示。鼓膜热疗定义的阈值通常定义值用（37.5C，38C或38.5C），皮肤温度的敏感性低于预期，阳性预测值较低。 我们试图利用皮肤温度预测鼓膜温度 38C（图2，图A）来确定最佳阈值（定义热疗）。ROC曲线下面积为0.873（95% CI 0.8070.917，P0.001）。皮肤肿瘤热疗的定义的最佳阈值为38C，一个条件在表1中已被评估。图2中面板B和C显示皮肤和鼓膜温度测量值之间的相关性（Bland和奥特曼图）。皮肤和鼓膜测量之间的相关性较差，红外测温仪在低值区低估了身体温度，在高值区高估了它的温度。多元回归分析显示：3个变量（鼓膜温度，室外温度和年龄）相关明显（P0.001），

25、皮肤和鼓膜的测量值之间的差值独立相关（表2）。表 1 预测增加的鼓膜温度中的皮肤温度诊断性能评价 图 2 A）比较接收器工作特性曲线（ROC）来显示敏感性之间的关系（真阳性），1特异性（真阴性）在确定皮肤温度值时预测高温的各种阈值。表 2 皮肤和鼓膜温度测量之间相关变量差异幅度结论 红外测温不能可靠地检测发热患者是由于其敏感性低于预期值且阳性预测值较低，这表明了假阳性结果有很高的比例。吴博士等人（5）对502名患者进行了研究，得出的结论是：红外热像仪可以适当地确定发热病人，报告表明ROC曲线下面积（0.972）较高，这类似于我们在本研究中发现的面积（0.925）。然而，这样的全球评估的价值是有

26、限的，由于人口中发热的发生率低。应确定的阴性预测值，而不是看的阳性预测值和准确性。如果考虑旅客人口或进入医院人口这个决定可能会导致更严重的后果 。 吴博士等人在皮肤温度测量时确定室外温度作为一个混杂变量。我们的研究发现年龄为变量，会影响皮肤的测量，但性别的作用不太明显。老年人在冷和热的压力下表现出核心温度受损的防御（稳定性），他们的皮肤血管反应性降低（12、13）。 使用一个简单的红外测温技术，而不是复杂的成像，不应被当做一个限制,因为这种方法涉及皮肤和核心温度之间的关系。我们可以推断结果到任何设备来估计皮肤温度和该软件计算的平均值。我们的研究试图发现发热病人 和没有感染的人。感染的质量检测，集中在对发热的检测，这意味着非发热病人不会被检测。这一点是很有用的因为在传染病中发烧不是一个常见的现象，病人可能已经服过退热药，在感染过程中低温就可能已经产生而不是热反应。 总之，我们观察到，通过使用红外测温仪测量皮肤温度不能提供可靠的依据来筛选的患者是否发热，因为皮肤和核心温度之间的梯度明显受患者年龄和环境特征的影响。使用这种技术检测发热患者不排除他假阳性结果会有很高的几率。 鸣谢 我们感谢戴维贝克审查的手稿。 这项研究是由健康、公共卫生和社会福利部提供支持，法国，巴黎。 专心-专注-专业