CORRESPONDENCE
and w i t h o u t a b a n d o n i n g t h e callers. Patrick ] Meehan, M D Patrick W O'Carro]], MD, MPH Division of Injury Epidemio]ogy m~d Control C D C Atlanta, Georgia 1. Shaffer D, Bacon K: A critical review of preventive intervention efforts in suicide, with particular reference to youth suicide, in: Alcohol, Drug
Abuse, and Menial Health Administration. Report of the Secretary's Task Force on Youth Suicide, Volume 3: Prevemiuns and Interventions in Youth Suicide. I)ttHS Pub No (ADM]89-1623. Washington, DC, tJS Government Printing Office, 1989. 2. Miller HL, Cnombs DW, Leeper JD, et ah An analysis of the effects of suicide prevention facilities on suicide rates in the United States. Am ] Public Health 1984;74:34(/-343. 3. Gingcrich W], Gurney RJ, Wirtz TS: How helpful are he/plines? A survey of callers, Social Casework: / Contemp Sac Work. 1988:634-639.
Tympanic Temperatures To the Editor." In t h e brief report e n t i t l e d " E v a l u a t i o n of a T y m p a n i c M e m b r a n e T h e r m o m e t e r in an O u t p a t i e n t C l i n i c a l Sett i n g " [ S e p t e m b e r 1989;18:1004-1006], t h e a u t h o r c a u t i o n s against ready a c c e p t a n c e of the First T e m p e d e v i c e as a r e p l a c e m e n t for the c u r r e n t l y used m e a n s of m e a s u r i n g b o d y t e m p e r a t u r e in an o u t p a t i e n t setting. His data, h o w ever, are based on f a u l t y a s s u m p t i o n s and study design. In p a r t i c u l a r , a l l o w i n g t h e i n c l u s i o n of oral t e m p e r a t u r e s as m e a s u r e d b y a g l a s s - m e r c u r y t h e r n m m e t e r to s e r v e as the c o n t r o l s t a n d a r d w e a k e n s t h e study. O r a l l y m e a s u r e d t e m p e r a t u r e s are n o t o r i o u s l y u n r e l i a b l e o w i n g to s u c h f a c t o r s as m o u t h - b r e a t h i n g , s m o k i n g , i m p r o p e r p l a c e m e n t of t h e t h e r m o m e t e r tip/probe, and r e c e n t ingest i o n of h o t or cold liquids.t,~ A n u m b e r of o t h e r a u t h o r s h a v e s h o w n t h a t the t y m p a n i c t e m p e r a t u r e s d e t e r m i n e d by this d e v i c e c o r r e l a t e h i g h l y w i t h e l e c t r o n i c a l l y determ i n e d rectal and c o r e t e m p e r a t u r e s in b o t h the critical care and o u t p a t i e n t setting. 3--~ I n t e r p r e t a t i o n of t h e t e m p e r a t u r e reading on this d e v i c e is f a c i l i t a t e d by the fact t h a t it can be p r o g r a m m e d to read o u t e i t h e r the " o r a l " or " r e c t a l " t e m p e r a t u r e e q u i v a l e n t , w h i c h is c a l c u l a t e d i n t e r n a l l y based on t h e c o n s t a n t relat i o n s h i p b e t w e e n the t y m p a n i c , oral, core, and rectal t e m p e r a t u r e s as d e t e r m i n e d f r o m s i m u l t a n e o u s m e a s u r e -
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m e n t s in a n u m b e r of patients. G i v e n t h e p r o l i f e r a t i o n of n e w m e d i c a l d e v i c e s a n d e q u i p m e n t o v e r t h e past decade w i t h little r e g u l a t o r y control, I agree t h a t t h e safety, a c c u r a c y , and r e l i a b i l i t y of t h e s e d e v i c e s / e q u i p m e n t s h o u l d be d e m o n s t r a t e d by w e l l d e s i g n e d , p r o s p e c t i v e s t u d i e s b e f o r e t b e y are w i d e l y acc e p t e d or rejected. A n d r e w J Auerbach, M D D e p a r t m e n t of Emergency Medicine Nova] Hospital San Diego, California I. Terndrup TE, Allegra JR, Kealy ]A: A comparison of oral, rectal, and tympanic lrrembrane-derived temperature changes after ingestion of liquids and snroking. Am J Emerg Med 1989;7:150-154. 2. Kresovich Wendler K, Levitt MA, Yearly L: An evaluation of clinical predictors to determine need for rectal tenrperature measurement in the emergency department. Am / Emerg Med 1989;7:391-394. 3. Shinozaki T, Dcane R, Perkins FM: Infrared tynrpanic thermometer: Evaluation of a new clinical thermometer. Crit Care Med 1988;16:148-150. 4. Ward L, Kaplan RM, Paris PM: A comparison of tympanic and rectal tenrperatures in the emergency department (abstract). Ann Emerg Me(] 1988;17:435. 5. Green MM, Danzl DF, Praszkier H: Infrared tympanic thermomography in tire emergency department. ] Emerg Med 1989;7:437-44/).
Annals of Emergency Medicine
19:9 September 1990
and w i t h o u t a b a n d o n i n g t h e callers. Patrick ] Meehan, M D Patrick W O'Carro]], MD, MPH Division of Injury Epidemio]ogy m~d Control C D C Atlanta, Georgia 1. Shaffer D, Bacon K: A critical review of preventive intervention efforts in suicide, with particular reference to youth suicide, in: Alcohol, Drug
Abuse, and Menial Health Administration. Report of the Secretary's Task Force on Youth Suicide, Volume 3: Prevemiuns and Interventions in Youth Suicide. I)ttHS Pub No (ADM]89-1623. Washington, DC, tJS Government Printing Office, 1989. 2. Miller HL, Cnombs DW, Leeper JD, et ah An analysis of the effects of suicide prevention facilities on suicide rates in the United States. Am ] Public Health 1984;74:34(/-343. 3. Gingcrich W], Gurney RJ, Wirtz TS: How helpful are he/plines? A survey of callers, Social Casework: / Contemp Sac Work. 1988:634-639.
Tympanic Temperatures To the Editor." In t h e brief report e n t i t l e d " E v a l u a t i o n of a T y m p a n i c M e m b r a n e T h e r m o m e t e r in an O u t p a t i e n t C l i n i c a l Sett i n g " [ S e p t e m b e r 1989;18:1004-1006], t h e a u t h o r c a u t i o n s against ready a c c e p t a n c e of the First T e m p e d e v i c e as a r e p l a c e m e n t for the c u r r e n t l y used m e a n s of m e a s u r i n g b o d y t e m p e r a t u r e in an o u t p a t i e n t setting. His data, h o w ever, are based on f a u l t y a s s u m p t i o n s and study design. In p a r t i c u l a r , a l l o w i n g t h e i n c l u s i o n of oral t e m p e r a t u r e s as m e a s u r e d b y a g l a s s - m e r c u r y t h e r n m m e t e r to s e r v e as the c o n t r o l s t a n d a r d w e a k e n s t h e study. O r a l l y m e a s u r e d t e m p e r a t u r e s are n o t o r i o u s l y u n r e l i a b l e o w i n g to s u c h f a c t o r s as m o u t h - b r e a t h i n g , s m o k i n g , i m p r o p e r p l a c e m e n t of t h e t h e r m o m e t e r tip/probe, and r e c e n t ingest i o n of h o t or cold liquids.t,~ A n u m b e r of o t h e r a u t h o r s h a v e s h o w n t h a t the t y m p a n i c t e m p e r a t u r e s d e t e r m i n e d by this d e v i c e c o r r e l a t e h i g h l y w i t h e l e c t r o n i c a l l y determ i n e d rectal and c o r e t e m p e r a t u r e s in b o t h the critical care and o u t p a t i e n t setting. 3--~ I n t e r p r e t a t i o n of t h e t e m p e r a t u r e reading on this d e v i c e is f a c i l i t a t e d by the fact t h a t it can be p r o g r a m m e d to read o u t e i t h e r the " o r a l " or " r e c t a l " t e m p e r a t u r e e q u i v a l e n t , w h i c h is c a l c u l a t e d i n t e r n a l l y based on t h e c o n s t a n t relat i o n s h i p b e t w e e n the t y m p a n i c , oral, core, and rectal t e m p e r a t u r e s as d e t e r m i n e d f r o m s i m u l t a n e o u s m e a s u r e -
184/1078
m e n t s in a n u m b e r of patients. G i v e n t h e p r o l i f e r a t i o n of n e w m e d i c a l d e v i c e s a n d e q u i p m e n t o v e r t h e past decade w i t h little r e g u l a t o r y control, I agree t h a t t h e safety, a c c u r a c y , and r e l i a b i l i t y of t h e s e d e v i c e s / e q u i p m e n t s h o u l d be d e m o n s t r a t e d by w e l l d e s i g n e d , p r o s p e c t i v e s t u d i e s b e f o r e t b e y are w i d e l y acc e p t e d or rejected. A n d r e w J Auerbach, M D D e p a r t m e n t of Emergency Medicine Nova] Hospital San Diego, California I. Terndrup TE, Allegra JR, Kealy ]A: A comparison of oral, rectal, and tympanic lrrembrane-derived temperature changes after ingestion of liquids and snroking. Am J Emerg Med 1989;7:150-154. 2. Kresovich Wendler K, Levitt MA, Yearly L: An evaluation of clinical predictors to determine need for rectal tenrperature measurement in the emergency department. Am / Emerg Med 1989;7:391-394. 3. Shinozaki T, Dcane R, Perkins FM: Infrared tynrpanic thermometer: Evaluation of a new clinical thermometer. Crit Care Med 1988;16:148-150. 4. Ward L, Kaplan RM, Paris PM: A comparison of tympanic and rectal tenrperatures in the emergency department (abstract). Ann Emerg Me(] 1988;17:435. 5. Green MM, Danzl DF, Praszkier H: Infrared tympanic thermomography in tire emergency department. ] Emerg Med 1989;7:437-44/).
Annals of Emergency Medicine
19:9 September 1990
