Evaluation of tympanic membrane thermometer for use with pediatric patients

To determine if a tympanic membrane thermometer is of benefit on a pediatric unit. Temperature readings using a tympanic membrane thermometer and an electronic thermometer were compared for 295 paired observations. The electronic temperature readings were done by rectal (n = 32), oral (n = 65), and axillary (n = 198) routes. Differences in tympanic and electronic readings were compared by paired t-tests, and the readings were also correlated. The nursing time in seconds was also compared between electronic and tympanic measurements. Parents and nurses rated their opinion of each type of measurement on a 0-5 Likert scale. Nurses rated the patient's response using the same scale. Results indicate that temperature readings differ by an average of .2- .5 degree between tympanic and electronic thermometers. Correlations are statistically significant but of low-to-moderate strength. Parents and nurses did not rate the types of instruments differently. The nurses rated the electronic axillary method as being more acceptable to toddlers. The tympanic membrane measurement took an average of 30-38 seconds less time to take. Tympanic membrane thermometry saves nursing time. Although the correlations were not strong between electronic and tympanic membrane measurements, the tympanic reading was closer to the electronic rectal reading than to axillary or oral readings.     

Comparing no-touch and tympanic thermometer temperature recordings

Temperature is a vital sign which can be measured using various types of clinical thermometers. Pulmonary artery temperature is considered the 'gold standard', but this measurement is not usually clinically practical. There is currently no consensus for optimal alternative site or equipment. This research compares 178 simultaneous measurements from 5 clinical areas, using two types of thermometers: tympanic and no-touch temporal. No-touch thermometers were all set to oral equivalent. Tympanic thermometers were adjusted to either oral (n=105) or core (n=73) equivalent. Maximum acceptable difference was identified as 1oC. Two data sets (oral/core; oral/oral) were analysed using Bland-Altman method on Excel programmes, comparing all thermometers and separating oral and core-equivalent tympanics. The two thermometers were found not to be equivalent. As a simple comparison between two thermometers, this research cannot identify which thermometer is more accurate.     

NexTemp thermometer can be used interchangeably with tympanic or mercury thermometers for emergency department use

Objectives To determine the agreement between the chemical dot NexTemp thermometer with mercury and tympanic thermometers and the repeatability of measurements using these devices. Methods A prospective study involving a convenience sample of 194 consenting adult patients presenting to the ED, Freemasons Hospital, East Melbourne, Victoria, Australia. A survey of emergency medical staff was conducted to determine what they considered an acceptable level of agreement and repeatability for a putative new thermometer. The NexTemp thermometer’s performance was judged against this. For each thermometer, a set of two temperature measurements was made in every patient. The sequence of the set of readings (and hence device) was random between patients and the staff member performing one set was blinded to the results of the other two sets of readings in each patient. The method of Bland and Altman was used for assessing agreement and repeatability. Results Clinicians considered that a new thermometer should exhibit repeatability of ±0.3°C and agree with existing devices within ±0.5°C. The tympanic thermometer had 95% limits of repeatability of ?0.8–0.5°C compared with the NexTemp (?0.3–0.4°C) and mercury thermometers (?0.3–0.4°C). The NexTemp thermometer agreed with mercury thermometer within ?0.6–0.5°C. The tympanic thermometer agreed with the mercury thermometer within ?1.0–1.1°C. Conclusion Based on temperature measurement only, the NexTemp thermometer can be used interchangeably with current mercury and tympanic thermometers.     

Comparison of oral and tympanic temperatures in adult surgical patients.

Monitoring patients' temperatures is an important aspect of clinical nursing. In surgical areas, we rely on accurate temperature readings to determine appropriate therapy. Various body sites have been used for temperature measurement: oral, axillary, rectal, and tympanic. Oral temperature readings have long been considered the gold standard. However, oral temperature readings may be contraindicated, depending on surgical incision and level of consciousness or in cases of seizure. Tympanic temperature monitoring is often the next choice. The literature supports the accuracy of tympanic monitoring; however, some clinicians have questioned its accuracy. This study used a repeated-measures design to determine the reproducibility of tympanic and oral temperature measurements. A difference of 0.2 degrees C was considered clinically significant. Outcome data indicated that variability was similar with oral and tympanic temperatures. There was no significant difference between average tympanic and average oral temperatures. Therefore, this study supports the use of tympanic thermometers in addition to oral thermometers in obtaining temperatures.     

The tympanic membrane thermometer in paediatrics: a review of the literature

This literature review looks at published works on the accuracy, reliability and sensitivity of the tympanic membrane thermometer in the paediatric population, particularly in relation to those who present in the Accident and Emergency department.Decisions that influence patient care outcomes are often based on information obtained from taking the child's temperature. Numerous studies have been conducted to examine temperature sites and instruments used. The most recent temperature measuring device to be used by nurses in assessing their patients is the tympanic membrane thermometer. The advantages of tympanic membrane temperature measurement include ease of use, rapid results and convenience for both nurse and child.However, inconsistent study reports have revealed some concerns about the use of the tympanic membrane thermometer as a routine measurement tool of body temperature in children. To meet the goal of accurate assessment of body temperature the practitioner must understand the principles behind the use of the tympanic membrane thermometer and thus use it appropriately.     

A comparison of four methods of normal newborn temperature measurement

PURPOSE: The purpose of this study was to: (a) compare newborn temperature measurements obtained by digital disposable, electronic, and tympanic thermometers with glass mercury thermometers, and (b) compare financial implications of each method. METHODS: In this correlational study, 12 perinatal and neonatal nurses obtained temperature measurements of 184 newborns between 1 and 168 hours of age. The stratified convenience sample was selected using medical records numbers. Temperature instruments included glass thermometer, tympanic thermometer, electronic thermometer, and a digital thermometer. Data were analyzed by Pearson r coefficients, mean, standard deviation, and range using an SPSS statistical package. RESULTS: The glass thermometer, electronic thermometer, and digital thermometer temperature assessments were highly correlated (0.748-1.0). The tympanic thermometer had a low correlation coefficient (0.35). Use of the glass thermometer had the highest accompanying cost. Tympanic thermometers were the most cost effective. CLINICAL IMPLICATIONS: In healthy newborns, the use of electronic and digital thermometers can be encouraged if there is concern about using glass thermometers. These results cannot be extrapolated to sick infants. While tympanic thermometers had the lowest associated cost, their lack of correlation with the gold standard glass thermometers for accurate temperature assessment makes them a poor choice for healthy newborns.     

A comparison of tympanic thermometer readings to pulmonary artery catheter core temperature recordings

The purpose of this study was to determine the accuracy of FirstTemp (Intelligent Medical Systems, Carlsbad, CA) tympanic thermometer readings compared with core body temperatures obtained via pulmonary artery catheter (PAC). Five measurements were obtained on 19 cardiovascular surgery patients. Tympanic thermometer measurements tended to be higher than PAC measurements. However, most of the differences were not clinically significant. Differences found between right and left ear measurements were most likely due to poor measurement technique. When the correct technique is used, nurses can be confident that tympanic temperature readings are clinically accurate.     

The Accuracy of Oral Predictive and Infrared Emission Detection Tympanic Thermometers in an Emergency Department Setting

OBJECTIVE: To assess the accuracy of an oral predictive thermometer and an infrared emission detection (IRED) tympanic thermometer in detecting fever in an adult emergency department (ED) population, using an oral glass mercury thermometer as the criterion standard. METHODS: This was a single-center, nonrandomized trial performed in the ED of a metropolitan tertiary referral hospital with a convenience sample of 500 subjects. The temperature of each subject was taken by an oral predictive thermometer, an IRED tympanic thermometer set to "oral" equivalent, and an oral glass mercury thermometer (used as the criterion standard). A fever was defined as a temperature of 37.8 degrees C or higher. The subject's age, sex, triage category, and diagnostic group were also recorded. Sensitivity, specificity, positive and negative likelihood ratios, positive and negative predictive values, and corresponding 95% confidence intervals were calculated. Logistic regression was used to identify predictors of fever. RESULTS: The sensitivities and specificities for detection of fever of the predictive and the IRED tympanic thermometers were similar (sensitivity 85.7%/88.1% and specificity 98.7%/95.8%, respectively). The predictive thermometer had a better positive predictive value (85.7%) compared with the IRED tympanic thermometer (66.1%). The positive and negative likelihood ratios for the predictive oral thermometer were 65 and 0.14, respectively, and for the IRED tympanic thermometer 21 and 0.12, respectively, indicating that the predictive thermometer will "miss" 1 in about 7 fevers and the IRED tympanic thermometer will "miss" 1 in about 8 fevers. CONCLUSIONS: Although quick and convenient, oral predictive and IRED tympanic thermometers give readings that cannot always be relied on in the detection of fever. If we are to continue using electronic thermometers in the ED setting, we need to recognize their limitations and maintain the importance of our clinical judgment.     

Pediatric temperature measurement and child/parent/nurse preference using three temperature measurement instruments

This study compared the tympanic thermometer with the electronic and chemical dot thermometers used at the axillary site and evaluated child, parent, and nurse preferences for method of temperature measurement. The child's (n = 146) temperature was measured using each of the three methods. Each child, parent, and nurse was asked to select a preference for device and site. Results were analyzed using the Bland-Altman method. Results showed that most of the paired readings fell within the Bland-Altman limits of agreement (LOA). When the chemical dot and tympanic temperature readings were compared with the electronic axillary reading, the tympanic thermometer was found to be in closer agreement. The chemical dot thermometer placed in the axilla consistently read higher than the electronic thermometer in the same site. Children, parents, and nurses preferred the tympanic thermometer.     

红外耳温计与玻璃体温计测量中的差异比较与研究

目的探讨红外耳温计与玻璃体温计在测量中的差异,研究耳温和腋温之间的关系。方法把110例病人,分为普通组30例,发热组80例,分别比较普通组、发热组耳温和腋温之间的差异。结果红外耳温计能反映正常体温变化,左右耳的平均温度误差较小,发热组病人的耳温和腋温的差异有高度显著性。结论红外耳式体温计测温快速、安全、测量准确、使用简单方便。     

Temperature measurement in critically ill adults: a comparison of tympanic and oral methods.

BACKGROUND: Despite increasing use of tympanic thermometers in critically ill patients who do not have a pulmonary artery catheter in place, variations in measurements obtained with the thermometers are still a problem. OBJECTIVE: To compare the range of variability between tympanic and oral electronic thermometers. METHODS: Subjects were a convenience sample of 72 patients admitted to a 24-bed adult medical-surgical intensive care unit. For each patient, temperatures were measured concurrently (within a 1-minute period) with an oral (Sure Temp 678) thermometer, a pulmonary artery catheter (Baxter VIP Swan-Ganz Catheter), and 2 tympanic (FirstTemp Genius II and ThermoScan Ear Pro-1) thermometers. Each subject was used up to 3 times for data collection. Measurements obtained with the oral and tympanic thermometers were compared with those obtained with the pulmonary artery catheter. Nonparametric analysis of data was used. RESULTS: The magnitude of error for the ThermoScan tympanic thermometer differed significantly from that of the Genius II tympanic thermometer and the SureTemp oral thermometer (P < .001). Application of the Bland and Altman method to frame the data on the basis of an accuracy tolerance zone of +/-0.5 degrees C indicated variability with both the oral and tympanic methods. The overall degree of variability was lower for the oral thermometer. CONCLUSIONS: Oral thermometers provide less variable measurements than do tympanic thermometers. Use of oral thermometry is recommended as the best practice method for temperature evaluation in critical care patients when measurement of core temperature via a pulmonary artery catheter is not possible.     

Impact of operator technique and device on infrared emission detection tympanic thermometry

Preliminary data on the use of infrared emission detection (IRED) tympanic thermometers suggest that operator technique may be important in IRED readings. No systematic investigation of specific technique and available IRED devices has previously been performed. In a prospective, blinded trial, 40 healthy adult subjects using six IRED thermometers with two techniques were examined in random sequence. Differences between IRED tympanic, oral, and rectal temperatures were compared using ANOVA. Significant differences were observed between all temperatures, the IRED devices, and the method of probe insertion. Differences between oral or rectal temperatures and IRED tympanic readings were reduced by an ear tug (as for routine otoscopy) for all but one device. An “ear tug” results in increased IRED readings that may improve accuracy of tympanic thermometers using IRED.     

Reexamining age,race, site,and thermometer type as variables affecting temperature measurement in adults - A comparison study

BACKGROUND: As a result of the recent international vigilance regarding disease assessment, accurate measurement of body temperature has become increasingly important. Yet, trusted low-tech, portable mercury glass thermometers are no longer available. Thus, comparing accuracy of mercury-free thermometers with mercury devices is essential. Study purposes were 1) to examine age, race, site as variables affecting temperature measurement in adults, and 2) to compare clinical accuracy of low-tech Galinstan-in-glass device to mercury-in-glass at oral, axillary, groin, and rectal sites in adults. METHODS: Setting 176 bed accredited healthcare facility, rural northwest USParticipants Convenience sample (N = 120) of hospitalized persons GreaterEqual; 18 years old.Instruments Temperatures ( degrees F) measured at oral, skin (simultaneous), immediately followed by rectal sites with four each mercury-glass (BD) and Galinstan-glass (Geratherm) thermometers; 10 minute dwell times. RESULTS: Participants averaged 61.6 years (SD 17.9), 188 pounds (SD 55.3); 61% female; race: 85% White, 8.3% Native Am., 4.2% Hispanic, 1.7 % Asian, 0.8% Black. For both mercury and Galinstan-glass thermometers, within-subject temperature readings were highest rectally; followed by oral, then skin sites. Galinstan assessments demonstrated rectal sites 0.91 degrees F > oral and FullEqual; 1.3 degrees F > skin sites. Devices strongly correlated between and across sites. Site difference scores between devices showed greatest variability at skin sites; least at rectal site. 95% confidence intervals of difference scores by site ( degrees F): oral (0.142 - 0.265), axilla (0.167 - 0.339), groin (0.037 - 0.321), and rectal (-0.111 - 0.111). Race correlated with age, temperature readings each site and device. CONCLUSION: Temperature readings varied by age, race. Mercury readings correlated with Galinstan thermometer readings at all sites. Site mean differences between devices were considered clinically insignificant. Still considered the gold standard, mercury-glass thermometers may no longer be available worldwide. Therefore, mercury-free, environmentally safe low-tech Galinstan-in-glass may be an appropriate replacement. This is especially important as we face new, internationally transmitted diseases.     

Tympanic thermometer. The left or the right ear?

One alternative method to use of a mercury thermometer to measure body temperature is the reading of the tympanic temperature with an infrared ray thermometer. The authors evaluate the concordance among the temperatures registered with different infrared thermometers in each ear and in the both ears of the same patient. Tympanic temperature was registered in 147 patients, 76 men and 71 women, between the ages of 5 and 88, using two Firstemp Genius model 3000A thermometers. Each patient had their temperature recorded with both thermometers in each ear. The concordance among the temperatures recorded in the same ear of each patient was calculated according to the Bland and Altman method. The temperature between both ears in each patient was compared using a temperature of 38 degrees C as the reference point to use to calculate the Cohen kappa index and the percentage of disparity. The investigators employed a logistical regression to identify factors which are associated with this disparity. In the same ear, with a different thermometer, the same disparity was produced, 8%, in the right ear as well as in the left. When considering different ears, the Cohen kappa index was 0.70 and the disparity was 11%. The disparity which was produced among the recordings in the same ear using identical thermometers and between the right and left ear readings exceed the limits of chance. The authors recommend that tympanic temperature be registered in the right ear or in both ears in which case the highest reading should be recorded.     

Infrared tympanic thermometers are unreliable in low ambient temperatures

Study objective To assess the accuracy of infrared emission detection tympanic thermometers at ambient temperatures near and below their specified operating ambient temperature range. Methods In a pilot and subsequent study, two operators, using two brands of infrared emission detection thermometers in ambient temperatures ranging from 24.6°C to ?22.1°C measured tympanic temperatures of five healthy male volunteers. Each tympanic temperature measurement was taken twice by each operator, with both thermometers, in both ears of each subject. Results were compared with the subjects’ rectal temperatures taken simultaneously. Results A total of 240 tympanic temperature readings were made. In all ambient temperatures there was close agreement between operators and between left and right ears. With decreasing ambient temperatures there was an increasing and significant difference between rectal and tympanic temperatures. Tympanic temperatures were always lower than rectal readings. Both thermometers only gave warning displays of low ambient temperature when used in ambient temperatures well below their specified operating range. Only one brand continued to give readings at very low ambient temperatures and these were substantially inaccurate. Conclusions Infrared emission detection thermometers have limitations in low ambient temperatures. Operators should be aware of these limitations. Development of models of infrared emission detection devices with a wider operating ambient temperature range may be appropriate for use in the field.     

Temperature measurement: comparison of non-invasive methods used in adult critical care

Aims and objectives. To assess accuracy and reliability of two non‐invasive methods, the chemical (Tempa.DOT^TM) and tympanic thermometer (Genius^TM First Temp M3000A), against the gold standard pulmonary artery catheter, and to determine the clinical significance of any temperature discrepancy using an expert panel. Background. There is continued debate surrounding the use of tympanic thermometry in clinical practice. Design. Prospective study. Methods. A total of 160 temperature sets were obtained from 25 adult intensive care patients over a 6‐month period. Results. About 75.2% (n = 115) of chemical and 50.9% (n = 78) of tympanic readings were within a ±0.0–0.4 °C range of the pulmonary artery catheter. Both the chemical and tympanic thermometers were significantly correlated with temperatures derived from the pulmonary artery catheter (r = 0.81, P < 0.0001 and r = 0.59, P < 0.0001) and limits of agreement were ?0.5–0.9 °C and ?1.2–1.2 °C respectively. The chemical thermometer was associated with a mean temperature difference of 0.2 °C, which increased 0.4 °C when used in conjunction with a warming blanket. With regard to clinical significance 15.3% (n = 26) of chemical and 21.1% (n = 35) of tympanic readings might have resulted in patients receiving delayed interventions. Conversely 28.8% (n = 44) of chemical and 37.8% (n = 58) of tympanic readings might have resulted in patients receiving unnecessary interventions. Conclusions. The chemical thermometer was more accurate, reliable and associated with fewer clinically significant temperature differences compared with the tympanic thermometer. However, compared with the pulmonary artery catheter both methods were associated with erroneous readings. In the light of these findings and previous research evidence, it is becoming increasingly difficult to defend the continued use of tympanic thermometry in clinical practice. However, as chemical thermometers are not without their limitations, further research needs to be undertaken to evaluate the accuracy and reliability of other non‐invasive methods. Relevance to clinical practice. Chemical and tympanic thermometers are used in both adults and children in a wide variety of settings ranging from community to intensive care. As such these findings have significant implications for patients, users and budget holders.     

Comparison of tympanic and oral temperatures in surgical patients

The purpose of this study was to compare tympanic and oral temperatures at four times during the perioperative period in 60 adults having major abdominal surgery. Tympanic temperature was measured with an infrared thermometer and oral temperature with a predictive thermistor thermometer. Measurements at the two sites were similar in pattern and moderately well correlated. Tympanic temperature was somewhat more sensitive to the effects of an intervention influencing body temperature. The tympanic-oral temperature offset was relatively stable over time, with tympanic readings having a smaller range of values at each measurement. Tympanic temperature measurement variation was fairly small, with 92% of readings reproducible within 0.5 degree F (0.3 degree C); comparable oral data were not available. The findings suggest that the tympanic site offers some advantage, but that either tympanic or oral readings would be satisfactory for routine intermittent monitoring of body temperature during the perioperative period.     

Accuracy of noninvasive core temperature measurement in acutely ill adults: the state of the science

Accurate temperature measurement is critical to the assessment and management of temperature fluctuation in the acutely ill adult. Unfortunately, an accurate, noninvasive method to measure core temperature has yet to be established, and current instruments produce a wide range of temperatures for any given patient. This article provides an integrative review of studies comparing selected invasive and noninvasive temperature measurement methods in acutely ill, hospitalized adult patients. Medline and CINAHL databases were searched to locate published studies on temperature measurement in the adult hospitalized patient. A partial list of primary search terms included core temperature measurement, oral temperature measurement, temporal artery thermometry, and tympanic thermometers. Studies that were data based and included comparison of a tympanic, temporal artery, and/or oral noninvasive temperature measurement to a pulmonary artery or esophageal invasive core measurement in an adult population were included in the analysis. The search method produced 223 publications and abstracts for initial review; 23 (10%) met the inclusion criteria. The only study evaluating the use of temporal artery thermometry in the adult population found the instrument to be unreliable. Results also indicate that high-quality evidence supporting the accuracy of tympanic thermometry, the preferred instrument for noninvasive core temperature measurement in many acute care settings, is lacking, and in fact, the most recent high-quality studies evaluating the accuracy of this instrument fail to show support for its use. Evidence does, however, support the use of oral thermometry as an accurate means of temperature assessment in the adult, acutely ill population.     

The patient: a novel source of error in clinical temperature measurement using infrared aural thermometry

INTRODUCTION: The vital signs are an important component of patient assessment. With respect to body temperature; there has been a move away from mercury-in-glass thermometers toward the relatively inexpensive, safer to use infrared tympanic, auricular, or ear thermometer. Although already in widespread use, the reliability of these devices has increasingly been called into question. Few studies, however, have considered that the problem might reside outside the device itself. OBJECTIVE: To investigate the correlation between left ear temperature and right ear temperature using an infrared tympanic thermometer (ITT). DESIGN: A prospective, single-blind trail with randomized assignment of the first ear to be assessed. SETTING/LOCATION: Welsh Institute of Chiropractic (WIOC), University of Glamorgan. SUBJECTS: One hundred and thirty two (132) asymptomatic subjects who were opportunistically sampled on entry into the WIOC. None of the subjects had any neurologic deficit, or any known underlying pathologic problems. All were students at the University of Glamorgan (age range, 18-48 years). A smaller sample of the same cohort was used on a separate occasion to compare ITTs from 2 different manufacturers using the same protocol. INTERVENTION: Measurement of ear (ear canal/tympanic) temperature bilaterally using an ITT. OUTCOME MEASURES: Bilateral asymmetry in ear canal temperature. Analysis consisted of nonparametric statistical tests, using Spearman's correlation for comparison and the Wilcoxon matched pairs test for differences. RESULTS: In 132 subjects who completed the main study, although a degree of correlation was found, the relationship did not extrapolate through zero. At temperatures more than 0.4 degrees C above or below 36.7 degrees C, there was a significant difference in temperature in the left compared with the right ear. Additionally, the left ear tended to register a lower temperature than the right ear at temperatures below 36.7 degrees C, whereas the left ear tended to read a higher temperature than the right ear above 36.7 degrees C. CONCLUSIONS: The authors suggest that clinicians consider measuring both ears, and take the greater of the readings to be a more accurate reflection of the patient's core temperature. The difference may perhaps even be related to the person's health. This change in methodology should increase the reliability of the measurement and go some way toward restoring confidence in the use of ITT devices.