Temperature of the Great Toe as an Indication of the Severity of Shock

Abstract

To establish whether changes in skin temperature would provide objective indication of the presence and severity of shock, hemodynamic and temperature measurements were obtained with the aid of a digital computer. Values obtained 3 hours after admission and 3 hours prior to discharge or death in 100 patients who presented with clinical signs of circulatory shock were analyzed. Temperature was measured with standard thermistor probes at five sites: the digital pad of the third finger, the large toe, the deltoid region of the arm, the lateral portion of the thigh, and the rectum. A significant correlation was demonstrated between the cardiac output and temperature of the toe (r = 0.71). Correlations were increased to 0.73 when corrections were made for changes in ambient temperature. A stepwise regression analysis provided no significant improvement in the predictability of cardiac index when the values for temperatures of other skin sites were included. Discriminant function analysis showed that an early measurement of toe temperature correctly predicts patient outcome 67% of the time.