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The Use of Non-Invasive Thermometers in Healthcare Facilities: a Scoping Review Protocol

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The Use of Non-Invasive Thermometers in Healthcare Facilities: a Scoping Review Protocol SYSTEMATIC REVIEW PROTOCOL The use of non-invasive thermometers in healthcare facilities: a scoping review protocol 1,2 3 1 Siti Zubaidah Mordiffi Micah D.J. Peters Emily N.K. Ang 1Singapore National University Hospital (NUH) Centre for Evidence-Based Nursing: a Joanna Briggs Institute Centre of Excellence, Singapore, 2Nursing Department, National University Hospital, Singapore, and 3The Joanna Briggs Institute, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, Australia Review objective and questions: The objective of the review is to map the available evidence to provide an overview of the use of non-invasive thermometers in the general context of health care. The specific questions, in regards to the available international published and unpublished literature, are: What types of non-invasive thermometers have been used? What manufacturers/brand of thermometers have been used? What routes have been used for the thermometers? What thermometers have been used as reference thermometers? What measures of accuracy have been reported in studies comparing different thermometers and routes of temperature measurement? How have included studies reported on comparisons of different thermometers in terms of frequency of thermometer readings, time that temperature is measured and factors affecting accuracy? Keywords Accuracy; body temperature; in-patient; temperature; thermometer Background Failure of thermometers to accurately measure n healthcare facilities, vital signs are measured to body temperature may result in missed abnormal I monitor the patient’s physiological condition and body temperatures, which may compromise patient progress of their illness. Body temperature is one of safety when deterioration is not detected in a timely four vital signs that are monitored when a person is manner.1 The normothermic range is between 368C ill.1 Abnormal body temperature, such as hypother- and 37.58C.1,3 Early signs of hyperthermia may mia or hyperthermia, may indicate signs of illness manifest in giddiness, confusion, delirium and and warrant treatment.2 The temperature of patients exhaustion, whereas persons with hypothermia who are admitted to healthcare facilities is measured may manifest loss of memory, depression, poor judg- as part of standard routine medical care. Indications ment, decreased heart rate, respiration rate and for measuring the patient’s body temperature are, for blood pressure.4 In people with fever (hyperther- the purpose of establishing the baseline temperature, mia), for every 18C rise in temperature, there is a close observations for timely detection of hypother- 10% increase in the rate of enzyme controlled chemi- mia or hyperthermia, for observing and monitoring cal reactions.5 At 438C or higher, irreparable cell fever (a sign of infection), monitoring effects of damage and enzyme denaturation occurs, resulting antimicrobial therapy and observing for signs of in death. Conversely, in the case of hypothermia, as transfusion reaction.1 body temperature decreases below 338C, cellular processes become sluggish.5 As the metabolic rate falls, loss of consciousness may occur and, poten- Correspondence: Siti Zubaidah Mordiffi, [email protected] tially, death. Body temperatures should therefore be The authors SZM and ENKA declare that they possess no conflicts of measured accurately and reliably as temperature is interest in relation to this protocol or proposed review. The author MDJP declares that he is an Associate Editor of the JBI Database of an important factor that influences diagnoses and 1 Systematic Reviews and Implementation Reports and that he has the determination of the resulting treatment plan. had no input into the editorial process for this manuscript. Core temperature at sites such as the heart and the DOI: 10.11124/JBISRIR-2016-003173 brain are the most accurate ‘‘true’’ representation of JBI Database of Systematic Reviews and Implementation Reports ß 2016 THE JOANNA BRIGGS INSTITUTE 106 ©2016 Joanna Briggs Institute. Unauthorized reproduction of this article is prohibited. SYSTEMATIC REVIEW PROTOCOL S.Z. Mordiffi et al. body temperature.6 The temperature at these areas used at various sites (rectal, pulmonary artery, oral, are tightly regulated and are most accurate.7 How- brain and bladder).11 The temporal artery ther- ever, they are invasive and are not easily accessible or mometers measured the body temperature on the convenient.7 While there are different views regard- forehead and behind the ear. While findings of the ing which site is the most accurate, the most accurate review were inconclusive, temporal artery ther- core temperature can only be taken through invasive mometers were slightly more accurate than in-ear routes such as via the esophagus and pulmonary thermometers. A limitation of this review was that artery.1,4,8 This degree of accuracy may be required the focus was solely on contact temporal artery and for critically ill patients and these invasive methods tympanic thermometers; this proposed scoping are most feasible in highly acute care areas such as review will not have these restrictions. Furthermore, intensive care units4,8 or operating rooms.7 In less- the review reported no information on the brands acute care settings, invasive measurement of core evaluated. An additional limitation of the older temperature is unduly complex, carries an unnecess- review is that more recently published evidence ary risk to patients and is summarily unfeasible.1,7,9 around non-contact temporal artery thermometers For these reasons, a less-invasive, simpler and safe is now available. For these reasons, a broader, more method is likely to be a preferred option for both detailed scoping review is warranted to map the patients and clinicians. Non-invasive sites that pro- current literature. vide the best estimation of core temperatures include The search also sought existing systematic oral, axillary, temporal artery and external auditory reviews on the accuracy of non-invasive ther- canal (tympanic) due to their proximity to the core mometers. Two were located. One evaluated regions of the body and the presence of large blood accuracy of infrared tympanic, rectal and oral per- vessels.6 Thus, temperatures taken from peripheral ipheral thermometers and compared them with pul- or ‘‘near core’’ sites are more commonly and con- monary artery and bladder thermometers in febrile veniently used.7 However, these thermometers have patients.8 This review concluded that tympanic and limitations as they are more likely to be affected oral thermometers provide an accurate measure of by ambient temperatures.7 This explanation high- core temperature and highlighted the dearth of lights the significance of the differences between papers on some brands of peripheral thermometers the measurement of core temperature and surface currently used in clinical practice. The review also temperature and concomitantly, the necessity of reported major statistical flaws in many studies. This accurate thermometers for the measurement of both. resulted in the exclusion of studies considering blad- User technique can also impact upon accuracy of der thermometers. The exclusion of a number of temperature readings.1 This has been identified in papers was acknowledged by the authors as a poten- previous studies. In one study, the accuracy of a tial source of publication bias. As the present scoping temporal artery scanner thermometer was measured review will seek to map all relevant literature regard- against a disposable temporal artery thermometer.10 less of quality, this limitation will be avoided. The The temporal artery scanner thermometer was not as other systematic review12 evaluated the accuracy of sensitive as the disposable temporal artery scanner infrared tympanic, temporal artery, axilla and oral thermometer in detecting patients with fever.10 The peripheral thermometers against pulmonary, results of this study led to a recommendation that urinary bladder, esophageal or rectal central ther- more research is required to identify accurate and mometers in both adults and children from acute reliable non-invasive thermometers. care or ambulatory facilities.12 In contrast to the An initial search of the JBI Database of System- previous review,8 this review concluded that the atic Reviews and Implementation Reports, the peripheral thermometers do not have clinically Cochrane Database of Systematic Reviews, MED- acceptable accuracy and should not be recom- LINE (PubMed) and CINAHL, Google and Google mended in acute settings.12 Nevertheless, in less- Scholar was conducted in November-December acute areas, electronic oral and tympanic membrane 2015. A published scoping report was located thermometers were recommended for practical related to this topic.11 This scoping report evaluated reasons.12 This review included studies that eval- temporal artery thermometers, infrared in-ear ther- uated mercury thermometers that are now obsolete mometers and reference standard thermometers due to toxicity risks.12 In both reviews, the studies JBI Database of Systematic Reviews and Implementation Reports ß 2016 THE JOANNA BRIGGS INSTITUTE 107 ©2016 Joanna Briggs Institute. Unauthorized reproduction of this article is prohibited. SYSTEMATIC REVIEW PROTOCOL S.Z. Mordiffi et al. included were from inception up to 2010,8 and July Concept 2015,12 respectively. These existing reviews8,11,12 The concepts examined by this scoping review are focused upon differing issues and reported conflict- the various
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