Preface

60,000,000 INCORRECT TEMPERATURES MAY BE LEADING TO 50,000 UNNECESSARY PATIENT DEATHS EACH YEAR.

This startling observation (Chapter1.1) is the essential motivation for our writing this Physicians Reference Handbook on Temperature. As reported recently by Pinner et al,1 infection as a contributor to mortality is implicated in over 1,000,000 deaths per year; as a direct cause of mortality, infectious disease ranks third behind cardiovascular disease and cancer; and alarmingly, infectious disease mortality is increasing dramatically in the United States. The National Academy of Sciences estimates that 20,000 deaths per year occur from hospital-acquired infections2. Temperature as a vital sign is nearly universally the first indication of infection, and its assessment the first line of defense. By introducing new methods of assessment by infrared thermometry in a well supported scientific style, we hope to show that significant improvements in patient outcome can be accomplished, while also reducing the cost of patient care. These methods have been proven in many of the most prestigious institutions in the world, and have been universally accepted by physicians who have taken the time to investigate for themselves. Unfortunately, there has been much confusion in the field of clinical infrared thermometry for a number of years due to marketing interests to both professional and consumer users taking precedence over thorough scientific and clinical work. As a result, "tympanic" thermometry has developed a deservedly low reputation due to poorly performing devices being marketed:fevers simply were not being detected reliably. Where used, these commonly available devices are relegated to novelty status, not to be taken seriously by physicians. The methods presented in this handbook and their instrumentality, are not the same as the commonly available devices. One of the principle objectives in writing the Handbook is to reverse the negative image and rebuild the foundation for the infrared method; which, when performed correctly, remains a compellingly attractive means of assessing patient temperature. To do so, we have introduced the concept of arterial temperature via heat balance at the ear (AHBE), a new and very powerful measurement modality. A major unanticipated benefit of this new method is the highly favorable patient response, due not only to the speed, comfort, and convenience, but also due to the hospital's employing a method of clearly higher quality and sophistication than can be purchased by the patient. Thermometry is such a powerful symbol of medical care that the quality of an institution's thermometry has a great deal of influence over the perception of quality by the patient. The scientific and clinical foundation presented in the Handbook is a partial presentation of the results of more than ten years of research leading to the design of this method. The material is organized in sections and chapters, each chapter presenting a specific topic or study, written largely in a handbook fashion to provide immediate answers to common questions on the practical day-today clinical requirements of thermometry, with some material repeated as required by the specific topic context. The general mathematical modeling and the experimental evidence that provide the foundation for our understanding of the relevant thermophysiology and thermal physics are entirely our original work. They are presented in order to demonstrate the fundamentals that made it possible to proceed with the confidence of success, and to provide those with a deeper interest the means to extend or challenge our work. Since the initial results of our use of infrared tympanic thermometry were unexpected and controversial, we also found it essential to develop and validate a mathematical model of temperature and thermal transport to explain the initially puzzling results, or allow a potentially great contribution to medicine to be discarded as a novelty. Since temperature is such an important and pervasive attribute of both the internal and external milieu, we thought a brief introduction to the historical development of medical thermometry would be appropriate. This introduction leads to our own work in this field, and the fascinating sequence of events that led us into it, based on the puzzling results of an experiment that failed to give the expected correlations. We believe we have accomplished the mission we set out for ourselves, as you can demonstrate for yourself, as have many of the most prestigious institutions in the world that rely exclusively on our methods. Thank you for your interest and we hope you find our Physicians Reference Handbook on Temperature as interesting, enlightening, and practical in your work, as we found it fascinating, challenging, and rewarding in our work in it's preparation. Marybeth A. Pompei Vice President and Chief Clinical Scientist Exergen Corporation Francesco Pompei President and CEO Exergen Corporation REFERENCES Pinner RW, Teutsch SM, Simonsen L, et al. Trends in infectious diseases mortality in the United States, ,JAMA, Vol 275, No. 3, January 17, 1996. Freeman J. Hospitals that infect, Harvard Magazine, Jul-Aug 1996, ppl 8-20.   e-mail: medical@exergen.com

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