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Peripheral thermometers not clinically accurate

In circumstances where body temperature will impact clinical choices, clinicians should use central thermometers, according to a review published in the Annals of Internal Medicine.

Daniel J. Niven, MD, MSc, an intensive care physician at Peter Lougheed Centre in Calgary, Alberta, and colleagues found that peripheral thermometers did not meet a level of clinically acceptable accuracy.

The researchers reviewed 75 studies they identified using MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials and CINAHL Plus. The studies encompassed 8,681 patients throughout 21 countries and five continents.

Results demonstrated that peripheral thermometers had pooled 95% limits of agreement outside the clinically acceptable range of ±0.5 C. For fever, the mean difference was –0.53 C in children (LOA = –1.49 C to 0.43 C; P < .001) and –0.008 C in adults. (LOA = –1.44 C to 1.46 C; P < .001). For hypothermia, studies only included adults, and the mean difference was –0.09 C (LOA = –2.07 C to 1.90 C; P < .001) when compared with central thermometers.

Niven and colleagues also found low sensitivity (64%; 95% CI, 55-72; P < .001) and high specificity (96%; 95% CI, 93-97; P < .001) when peripheral thermometers were used to detect fever.

"Given the excellent level of agreement between nonvascular central thermometers and the pulmonary artery catheter — the gold standard — clinicians should consider using central thermometers when accurate measurement of a patient's temperature will influence diagnosis and management," the researchers wrote. "Rectal thermometers could be used for most of these patients, and bladder thermometers could be used for those requiring a bladder catheter."

Niven and colleagues noted that in cases when a central thermometer is best avoided, clinicians can use tympanic membrane thermometers for children and adults or electronic oral thermometers for adults as an alternative. – by Chelsea Frajerman Pardes

Disclosures: The authors report no relevant financial disclosures.