Screening for fever in an adult emergency department: oral vs tympanic thermometry.

The accuracy of tympanic thermometers in clinical practice continues to be questioned. We evaluated the Genius tympanic thermometer in our adult emergency department. All patients had both tympanic and oral temperature measurements. Patients with an oral or tympanic temperature > or = 100.0 degrees F had a rectal temperature taken. Oral and rectal measurements were taken with the IVAC 2080A electronic thermometer, and the Genius thermometer was used in the oral equivalent mode. All instruments were calibrated. Of the 332 patients entered into the study, 51 had oral or tympanic temperatures > or = 100.0 degrees F. Forty-one of these patients consented to a rectal temperature measurement. The correlation (r) between tympanic and oral, tympanic and rectal, and oral and rectal temperature was .845, .853, and .940, respectively. The oral thermometer identified all 28 febrile patients (rectal temperature > or = 100.4 degrees F). However, the tympanic thermometer detected fever in only 19 of these cases. Two patients in whom the tympanic thermometer failed to detect fever had AIDS, and their workup was altered by the detection of the fever. We conclude that the tympanic thermometer is not as sensitive as the oral thermometer in the detection of fever. The use of tympanic thermometers in the adult emergency department should be questioned.