Infrared thermometry in the diagnosis and treatment of heat exhaustion

Infrared (IR) thermometers (FirstTemp 2000A, Intelligent Medical Systems, California) were used to monitor tympanic temperature (Tty) in 12 collapsed fun-runners suspected of suffering exertion-induced heat exhaustion (EIHE). Rectal temperature (Tre) was monitored via digital clinical thermometers. Conditions during the fun-run and in the field treatment centre were cool (air temperature 16-18 degrees C, relative humidity 60-65%). On admission, Tty was (mean +/- SEM) 1.2 +/- 0.3 degrees C lower than Tre. For admission plus subsequent monitoring data pooled, although Tty correlated significantly with Tre (r = 0.86, p < 0.001), mean Tty (37.4 +/- 0.2 degrees C) was significantly lower (p < 0.01) than mean Tre (38.4 +/- 0.4 degrees C). Cotton wool ear pads, applied to 10 of the runners on admission to minimise environmental effects on Tty, did not significantly improve the IR monitoring. A Tty > or = 37.1 degrees C predicted a Tre > or = 38 degrees C (an established diagnostic criterion for EIHE) with a sensitivity of 0.93 and a specificity of 0.63. These data indicate that IR tympanic thermometry, when utilised in cool environments, can result in misdiagnosis of heat exhaustion. Although IR thermometry shows some promise as a rapid, non-invasive means of monitoring core temperature, it should not be used in the diagnosis and treatment of heat exhaustion unless further research validates the method.