Accuracy of tympanic temperature readings in children under 6 years of age
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Published on: January 23, 2017
D M Lanham1, B Walker, E Klocke
1Charleston Area Medical Center, WV, USA.
Insights
Infrared tympanic thermometry (ITT) is not recommended for detecting fever in children under 6. This study found its sensitivity and specificity to be unacceptably low for accurate fever screening in this age group.
Area of Science:
- Pediatrics
- Medical Devices
- Clinical Thermometry
Background:
- Infrared tympanic thermometry (ITT) is a common, non-invasive method for assessing fever in children.
- Concerns exist regarding the accuracy of ITT, specifically its sensitivity and specificity, in pediatric populations.
Purpose of the Study:
- To determine the correlation and agreement between rectal temperature (RT) and ITT readings.
- To evaluate the accuracy of ITT in detecting fever in children under 6 years of age.
Main Methods:
- A correlational study involving 241 paired ear and rectal temperature measurements.
- Participants were children under 6 years old requiring rectal temperature measurement in an emergency department.
- Tympanic measurements were taken alongside routine rectal temperatures.
Main Results:
- A statistically significant correlation was found between rectal and tympanic temperatures (r = 0.84, p < .001).
- The mean temperature difference was -0.60°C.
- Sensitivity was 80%, specificity 85%, positive predictive value 87%, and negative predictive value 85% for fever detection.
Conclusions:
- The sensitivity, specificity, and predictive values of ITT for fever detection in children under 6 are unacceptably low.
- The study does not support the use of tympanic thermometers for accurately detecting fever in this pediatric age group.
Purpose:
Infrared tympanic thermometry (ITT) is increasingly used as a convenient, noninvasive assessment method for febrile children. However, the accuracy of ITT for children has been questioned, particularly in relation to specificity and sensitivity. This study was designed to (a) determine the correlation and extent of agreement between rectal temperature (RT) readings obtained by electronic thermometer and ear-based temperature readings obtained by ITT, and (b) determine the accuracy of detecting fever in children under 6 years of age.
Methods:
This correlational study used a sample of 241 paired ear and rectal temperatures obtained in the emergency department (ED) of a 920-bed regional hospital. All children under the age of 6 years who routinely received a rectal temperature measurement were eligible to participate. According to the ED protocol, rectal temperatures were obtained on all patients less than 3 years or patients 3-6 years that presented with a complaint of fever. For the study, tympanic measurements were also taken.
Results:
Correlation between rectal and tympanic temperature readings was statistically significant (r = 0.84, p < .001). The mean difference between rectal and tympanic temperatures was -0.60 degrees C. Threshold-adjusted accuracy in screening for fever was determined by sensitivity (80%), specificity (85%), positive predictive value (87%), and negative predictive value (85%).
Conclusions:
Sensitivity, specificity, positive predictive value, and negative predictive value are unacceptably low and the number of children with fever who would be missed by screening with a tympanic thermometer is unacceptable. Findings of this study do not support the use of tympanic thermometers to detect fever in children under 6 years of age.
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