Does the technique employed for skin temperature assessment alter outcomes? A systematic review

Aaron J E Bach, Ian B Stewart, Geoffrey M Minett, Joseph T Costello
2015 Physiological Measurement  
The human body controls core body temperature within a tight band typically between 36 °C and 38 °C despite varying ambient temperatures. Thermoreceptors located within the hypothalamus, spinal cord, skin and some abdominal organs monitor temperature changes, and work via negative feedback to initiate autonomic mechanisms to either conserve (via shivering and vasoconstriction) or lose (via sweating and vasodilation) body heat (Casa et al., 2007). For example, when core temperature rises during
more » ... ature rises during exercise, the anterior hypothalamus detects the temperature of blood perfusing it and once temperatures exceed an internal set point, vasodilation of peripheral blood vessels and sweat production facilitates heat loss (Charkoudian, 2003). Conversely, when core temperature is reduced, heat conservation mechanisms such as vasoconstriction of peripheral blood vessels and autonomic muscle tremors (i.e. shivering thermogenesis) limit heat loss from the skin into the environment (Van Someren et al., 2002). As a result, is influenced by a number of factors including superficial blood flow, heat conduction from deeper tissues (including muscle) and heat loss along the skin's surface. The skin is also the site of reciprocal heat transfer between the human body and the external environment. The extent to which heat transfer occurs is largely dependent on the environmental conditions, such as ambient temperature, water vapour and the thermal properties of human skin (Prek and Butala, 2010). The most common methods of assessing are derived from conductive and infrared devices. These techniques measure temperature by applying different scientific principles of thermal heat transfer. Conductive devices are based upon the transfer of heat energy into the device through direct contact with the object of interest. At a molecular level, conduction refers to the transfer of heat energy that occurs in all substances (i.e., solid, liquid and gas) between hot, rapidly moving or vibrating molecules (Lyklema, 2001). These faster (hotter) moving molecules transfer some heat energy to colder neighbouring particles when they collide. In the case of human heat transfer, conduction refers to the direct contact between the body, typically the skin, and another surface. Heat is transferred from the warmer body, proportionate to the size of the temperature gradient, surface area of contact, pressure between the two bodies and specific conductivity of the surfaces (Hardy et al., 1938). There are a wide variety of types, makes and models of commercially available conductive devices. For the purpose of this review three of the most popular types of devices will be introduced. Thermocouples, thermistors and telemetry sensors (such as iButtons) are typical contact measures of that have been viewed as advantageous by clinicians due to the relatively low cost and the associated ease of use (Tyler, 2011). Thermocouples function as a result of an interaction known as the Seebeck effect; where by the temperature measured is proportional to the voltage between two dissimilar metals when in the presence of a temperature gradient (Klopfenstein, 1994). Thermocouples are advantageous due to their fast response and accuracy over very wide temperature ranges (Yadav et al., 2012). Thermistors are a wired sensor made from a semi-conductive metal that exhibits an inverse relationship between temperature and the electrical resistance within the device. Thermistors exhibit high thermal sensitivity, fast response rates and are very accurate when measuring temperatures within the human physiological range (Klopfenstein, 1994). In order to function, both thermocouples and thermistors require an associated data logger to control sampling rates and store recorded data. Wireless thermochron sensors, provide an alternative to more cumbersome wired counterparts as an autonomous encapsulated semiconductor computer chip that performs similar to a thermistor sensor that has been validated against thermocouples (van Marken Lichtenbelt et al., 2006) and thermistors (Harper Smith et al., 2010) . Typically, infrared devices are used as a non-contact form of measurement and consist of infrared thermometers and infrared thermal imaging cameras. All objects hotter than absolute zero, produce an electromagnetic wave of radiation proportional to the electrical charge given off by vibrating atoms and molecules that make up the object. Emissivity (ε) is the term used to describe the amount of absolute radiation energy released from an objects surface relative to an ideal black body (ε = 1.0) while objects with an ε = < 1.0 are referred to as a grey body (Bernard et al., 2013). The Stefan-Boltzmann law states that the power emitted per unit area of the surface of a black body is directly proportional to the fourth power of its absolute temperature: where E is total emissive power (W·m -2 ), ε is the emissivity of the object, σ represents the Stefan-Boltzmann Constant (5.67x10 -8 W·m -2 K 4 ) and T the absolute temperature (K). By knowing the emissivity coefficient of an object's surface it is possible to know the surface temperature of that object (Modest, 2013). Human skin, irrespective of ethnicity, has an emissivity resembling that of a perfect black body of approximately 0.98 (Boylan et al., 1992; Steketee, 1973) . Similar to conductive devices, infrared thermometers measure the average temperature over a small area, often referred to as a 'spot' measurement. There are infrared thermometers that require contact with the area of measurement (i.e., skin); however, the majority of infrared devices are held off the skin which allows for temperature measurements without any physical contact. An internal detector collects the infrared energy of an object with a relatively simple 'point and shoot' design with an associated laser sighting for aiming purposes. 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doi:10.1088/0967-3334/36/9/r27 pmid:26261099 fatcat:xlk7kymzdnehnc4fwepfxk4nhm