TITLE: Type of Thermometer for Inpatients: Clinical-Effectiveness and Guidelines

Transcription

1 TITLE: Type of Thermometer for Inpatients: Clinical-Effectiveness and Guidelines DATE: 28 May 2009 RESEARCH QUESTIONS: 1. What is the clinical-effectiveness of tympanic, temporal, oral, and rectal thermometers for inpatients? 2. What is the accuracy of tympanic, temporal, oral, and rectal thermometers for inpatients? 3. What are the guidelines for use of tympanic, temporal, oral, and rectal thermometers for inpatients? METHODS: A limited literature search was conducted on key health technology assessment resources, including PubMed, the Cochrane Library (Issue 2, 2009), University of York Centre for Reviews and Dissemination (CRD) databases, ECRI, EuroScan, international health technology agencies, and a focused Internet search. The search was limited to English language articles published between 2004 and May No filters were applied to limit the retrieval by study type. Internet links were provided, where available. The summary of findings was prepared from the abstracts of the relevant information. Please note that data contained in abstracts may not always be an accurate reflection of the data contained within the full article. RESULTS: HTIS reports are organized so that the higher quality evidence is presented first. Therefore, health technology assessment reports, systematic reviews, and meta-analyses are presented first. These are followed by randomized controlled trials, controlled clinical trials, observational studies, and evidence-based guidelines. Disclaimer: The Health Technology Inquiry Service (HTIS) is an information service for those involved in planning and providing health care in Canada. HTIS responses are based on a limited literature search and are not comprehensive, systematic reviews. The intent is to provide a list of sources of the best evidence on the topic that CADTH could identify using all reasonable efforts within the time allowed. HTIS responses should be considered along with other types of information and health care considerations. The information included in this response is not intended to replace professional medical advice, nor should it be construed as a recommendation for or against the use of a particular health technology. Readers are also cautioned that a lack of good quality evidence does not necessarily mean a lack of effectiveness particularly in the case of new and emerging health technologies, for which little information can be found, but which may in future prove to be effective. While CADTH has taken care in the preparation of the report to ensure that its contents are accurate, complete and up to date, CADTH does not make any guarantee to that effect. CADTH is not liable for any loss or damages resulting from use of the information in the report. Copyright: This report contains CADTH copyright material and may contain material in which a third party owns copyright. This report may be used for the purposes of research or private study only. It may not be copied, posted on a web site, redistributed by or stored on an electronic system without the prior written permission of CADTH or applicable copyright owner. Links: This report may contain links to other information available on the websites of third parties on the Internet. CADTH does not have control over the content of such sites. Use of third party sites is governed by the owners own terms and conditions.

2 One systematic review, one randomized controlled trial, ten observational studies, and one evidence-based guideline were identified regarding tympanic, temporal, oral, and rectal thermometers for inpatients. No relevant health technology assessments, systematic reviews, or controlled clinical trials were identified. Additional articles of interest may be found in the appendix. OVERALL SUMMARY OF FINDINGS: Seven articles discussed the use of thermometers in adult inpatient populations. 1,3-5,8,11,12 The conclusions reported among the studies were not consistent. In one study, 4 temperatures measured with temporal thermometers were found to be comparable with axillary temperature measurement. The systematic review on temporal thermometers was unable to recommend the use of temporal artery thermometers over existing methods due to conflicting and incomplete evidence identified. 1 Myny et al. 12 reported good reliability and accuracy of the temporal thermometer but concluded that it showed no substantial benefit over standard rectal, oral, or bladder measurement methods. Study conclusions regarding the use of tympanic thermometers for inpatients were also inconsistent. Moran et al. 8 found there was poor agreement between tympanic temperature measurement and core body temperature, as measured by pulmonary artery catheter. Dzarr et al. 3 concluded that tympanic measurement was more sensitive than either oral or axillary temperature measurement. Smitz et al. 5 found that tympanic measurements were as accurate as rectal temperature, when rectal temperature measurements were used as baseline in a geriatric population. Leon et al. 11 found tympanic measurements to be highly reliable when compared with axillary temperatures measured with a mercury-in-glass thermometer. Six articles discussed the use of thermometers in pediatric inpatient populations. 2,6,7,9,10,13 Two infant studies showed a significant difference in temperature based on location of measurement. 2,6 Axillary temperatures were much lower than rectal temperatures when measured with the same thermometer. 6 Devrim at al. 7 compared at-home tympanic, clinical tympanic, and standard mercury-in-glass thermometers. They observed that, when comparing the clinical tympanic thermometer to the standard mercury-in-glass, 4% of afebrile patients were misdiagnosed as febrile and 5% of febrile patients were misdiagnosed as afebrile when using the clinical tympanic thermometer. Nimah et al. 9 concluded that infrared tympanic thermometers are more accurate and showed better agreement with core temperature during fever cycles, as compared to temporal, axillary, and rectal temperature measurements. Hebbar et al. 10 measured temporal, rectal, axillary, and pulmonary artery core temperatures, in pediatric ICU patients. The sensitivity and specificity of temporal measurements for diagnosis were similar to axillary measurement. However, no measurement method was found to be sufficiently better to be recommended over rectal, or the other invasive measurements, for determining fever. One guideline 13 recommends axillary temperature measurement for infants up to four weeks of age, and either electronic axillary, tympanic, or chemical dot axillary measurement for children four weeks to five years of age. Overall, the studies showed that in adults, there was no significant benefit reported for the use of temporal thermometers over temperature measurement with oral, axillary, rectal, or bladder Type of Thermometer for Inpatients 2

3 temperature measurement. 1,4,12 Three studies determined tympanic temperature measurement was sensitive, 3 accurate, 5 and reliable in adults. 5 However, an additional study reported poor agreement with core temperature measurements. 8 In infants, rectal temperature measurement was found to be more accurate than axillary, 2,6 however, there are conflicting recommendations from the guidelines that suggest oral and rectal measurements not be used in children five years of age and younger. 13 No studies concluded that tympanic or temporal measurement was better than other temperature measurement methods in children. 7,9,10 Type of Thermometer for Inpatients 3

4 REFERENCES SUMMARIZED: Health technology assessments No literature identified Systematic reviews and meta-analyses 1. Temporal artery thermometry in the post-operative setting [VATAP short report]. Boston: US Department of Veterans Affairs; Available: (accessed 2009 May 28). Randomized controlled trials 2. Hutton S, Probst E, Kenyon C, Morse D, Friedman B, Arnold K, et al. Accuracy of different temperature devices in the postpartum population. J Obstet Gynecol Neonatal Nurs 2009;38(1):42-9. PubMed: PM Observational studies 3. Dzarr AA, Kamal M, Baba AA. A comparison between infrared tympanic thermometry, oral and axilla with rectal thermometry in neutropenic adults. Eur J Oncol Nurs PubMed: PM Marable K, Shaffer LE, Dizon V, Opalek JM. Temporal artery scanning falls short as a secondary, noninvasive thermometry method for trauma patients. J Trauma Nurs 2009;16(1):41-7. PubMed: PM Smitz S, Van de Winckel A, Smitz MF. Reliability of infrared ear thermometry in the prediction of rectal temperature in older inpatients. J Clin Nurs 2009;18(3): PubMed: PM Hissink Muller PC, van Berkel LH, de Beaufort AJ. Axillary and rectal temperature measurements poorly agree in newborn infants. Neonatology 2008;94(1):31-4. PubMed: PM Devrim I, Kara A, Ceyhan M, Tezer H, Uludag AK, Cengiz AB, et al. Measurement accuracy of fever by tympanic and axillary thermometry. Pediatr Emerg Care 2007;23(1):16-9. PubMed: PM Moran JL, Peter JV, Solomon PJ, Grealy B, Smith T, Ashforth W, et al. Tympanic temperature measurements: are they reliable in the critically ill? A clinical study of measures of agreement. Crit Care Med 2007;35(1): PubMed: PM Nimah MM, Bshesh K, Callahan JD, Jacobs BR. Infrared tympanic thermometry in comparison with other temperature measurement techniques in febrile children. Pediatr Crit Care Med 2006;7(1): PubMed: PM Hebbar K, Fortenberry JD, Rogers K, Merritt R, Easley K. Comparison of temporal artery thermometer to standard temperature measurements in pediatric intensive care unit patients. Pediatr Crit Care Med 2005;6(5): PubMed: PM Type of Thermometer for Inpatients 4

5 11. Leon C, Rodriguez A, Fernandez A, Flores L. Infrared ear thermometry in the critically ill patient. J Crit Care 2005;20(1): PubMed: PM Myny D, De Waele J, Defloor T, Blot S, Colardyn F. Temporal scanner thermometry: a new method of core temperature estimation in ICU patients. Scott Med J 2005;50(1):15-8. PubMed: PM Guidelines and recommendations 13. National Collaborating Centre for Women's and Children's Health. Feverish illness in children: assessment and initial management in children younger than 5 years [clinical guideline 47]. London: National Institute for Health and Clinical Excellence (NICE); Available: (accessed 2009 May 28). Note: see 1.1 Thermometers and detection of fever, page 9 PREPARED BY: Michelle Clark, BSc, Research Assistant Carolyn Spry, BSc, MLIS, Information Specialist Health Technology Inquiry Service htis@cadth.ca Tel: Type of Thermometer for Inpatients 5

6 APPENDIX FURTHER INFORMATION: Position statements 14. Temperature measurement in paediatrics. In: CPS position statements: community paediatrics. Ottawa: Canadian Paediatric Society (CPS); Available: (accessed 2009 May 28). Review articles 15. Reid J, Turner T, Harris C. Factors affecting the accuracy of infrared tympanic thermometers and digital/electronic or infrared axillary temperature recordings in children [evidence request b]. Clayton (AU): Monash University Centre for Clinical Effectiveness; Available: (accessed 2009 May 28). 16. Crawford DC, Hicks B, Thompson MJ. Which thermometer? Factors influencing best choice for intermittent clinical temperature assessment. J Med Eng Technol 2006;30(4): PubMed: PM Dew PL. Is tympanic membrane thermometry the best method for recording temperature in children? J Child Health Care 2006;10(2): PubMed: PM Hooper VD, Andrews JO. Accuracy of noninvasive core temperature measurement in acutely ill adults: the state of the science. Biol Res Nurs 2006;8(1): PubMed: PM CRD abstract: Additional references 19. How reliable are infrared aural thermometers? In: ATTRACT: other clinical. Cardiff (UK): National Public Health Service for Wales; Available: (accessed 2009 May 28). Type of Thermometer for Inpatients 6