CADTH RAPID RESPONSE REPORT: SUMMARY OF ABSTRACTS Tympanic Thermometer Use in Adults in a Hospital Setting: Accuracy, Clinical Effectiveness, and Guidelines

Service Line: Rapid Response Service Version: 1.0 Publication Date: February 06, 2018 Report Length: 8 Pages

Authors: Michelle Clark, Charlene Argáez

Cite As: Tympanic Thermometer Use in Adults in a Hospital Setting. Ottawa: CADTH; 2018 Feb. (CADTH rapid response report: summary of abstracts).

Acknowledgments:

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SUMMARY OF ABSTRACTS Ty mpanic Thermometer Use in Adults in a Hospital Setting 2

Research Questions

1. What is the accuracy of tympanic thermometers for determining the internal temperatures of adult patients in a hospital setting?

2. What is the comparative clinical effectiveness of tympanic thermometers to other thermometer types for determining the internal temperatures of adult patients in a hospital setting?

3. What are the evidence-based guidelines associated with the use of tympanic thermometers in determining the internal temperatures of adult patients in a hospital setting?

Key Findings

Two systematic reviews, five non-randomized studies, and one evidence-based guideline were identified regarding tympanic thermometer use in the hospital setting.

Methods

A limited literature search was conducted on key resources including PubMed, The Cochrane Library, University of York Centre for Reviews and Dissemination (CRD) databases and a focused Internet search. For research question 3, a methodological filter was applied to limit retrieval to guidelines. For all other research questions, no filters were applied to limit the retrieval by study type. The search was limited to English language documents published between January 1, 2013 and January 17, 2018. Internet links were provided, where available.

Selection Criteria

One reviewer screened citations and selected studies based on the inclusion criteria presented in Table 1.

Table 1: Selection Criteria Population Adult patients in a hospital setting (excluding: intensive care unit) Intervention Tympanic thermometers Comparator Q1-2: Other types of thermometers (infrared, temporal, oral, axillary, rectal) Q3: No comparator Outcomes Q1: Accuracy Q2: Comparative clinical effectiveness Q3: Guidelines Study Designs Health technology assessments, systematic reviews, meta-analyses, randomized controlled trials, evidence-based guidelines

SUMMARY OF ABSTRACTS Ty mpanic Thermometer Use in Adults in a Hospital Setting 3

Results

Rapid Response 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, non-randomized studies, and evidence-based guidelines.

Two systematic reviews, five non-randomized studies, and one evidence-based guideline were identified regarding tympanic thermometer use in the hospital setting. No relevant health technology assessments or randomized controlled trials were identified.

Additional references of potential interest are provided in the appendix.

Overall Summary of Findings

Two systematic reviews,1-2 five non-randomized studies,3-7 and one evidence-based guideline8 were identified regarding tympanic thermometer use in the hospital setting. The results of the identified studies generally concluded that tympanic thermometers were not as accurate as rectal measurement1-2,4 but equally7 or more accurate5 than axillary measurement. The guideline from the Emergency Nurses Association 8 indicates that there is insufficient evidence to recommend the use of tympanic thermometers for adults or patients who are critically ill or intubated. Additionally, there is no evidence to support the use of tympanic thermometers for patients who are hypothermic.8

Detailed study characteristics and conclusions are summarized in Table 2.

Table 2: Summary of Included Studies

First Author (Year) Population and Intervention and Results and Author’s Conclusions Setting Comparator(s) Systematic Reviews Niven (2015)1 Adults and children Peripheral  Most identified studies were at a high or unclear (N = 8682) thermometers risk of bias 75 studies  Tympanic membrane  Peripheral thermometers had low sensitivity and Not specified  Temporal artery high specificity when compared with central  Axillary thermometers for the detection of fever  Oral  The authors concluded that the results of peripheral thermometers were not acceptably Central thermometers accurate  Pulmonary artery catheter  Urinary bladder  Esophageal Rectal Geijer (2016)2 Clinical and healthy Temporal artery  The authors determined the quality of the patients, with or without thermometers evidence to be moderate 37 studies fever  Pooled sensitivity of temporal artery (N = 5026) Reference test thermometers was 0.72 and specificity was 0.94  The authors determined the results were similar Not specified to those for tympanic thermometers

SUMMARY OF ABSTRACTS Ty mpanic Thermometer Use in Adults in a Hospital Setting 4

First Author (Year) Population and Intervention and Results and Author’s Conclusions Setting Comparator(s)  The authors concluded that temporal artery thermometers were not accurate enough to replace reference methods, but could possibly replace tympanic thermometers Non-Randomized Studies Aadal (2016)3 Age of patients not Tympanic thermometer  Within patient variability was greater with specified tympanic thermometers (N = 27) Rectal thermometer  The authors determined there was a weak linear relationship between rectal and tympanic Hospital wards temperature measurements  Variation in measurement was observed with both methods but the variation was greater with the tympanic thermometer Bijur (2016)4 Adult patients Oral, tympanic  36% of tympanic membrane measurements (N = 987) thermometer, and differed from the rectal temperature by 0.5°C temporal artery  The sensitivity of a 38 degree Celsius cutoff point Urban emergency thermometer on tympanic membrane measurements was department 37.0% Rectal thermometer  The authors determined that none of the non- invasive measurement methods were sufficiently accurate when compared to rectal temperature Dakappa (2016)5 Adult patients with a Continuous tympanic  Tympanic temperature was measured at 1 history of fever temperature recording minute intervals for 24 hours and axillary (N = 55) temperature was measured 3 times Conventional mercury  The average peak tympanic temperature was Tertiary care hospital thermometer (axillar significantly higher than with the conventional measurement) thermometer  The authors concluded that the continuous tympanic temperature method was a better option for measuring actual temperature changes Yang (2016)6 Patients of all ages with Tympanic thermometer  The authors concluded that temporal fever, with or without thermometers were more reliable for patients chills Temporal thermometer less than one year of age and for patients (N = 710) between 18 and 65 years of age  The authors indicated that 0.7 to 0.8°C should be Emergency department added to tympanic temperatures of 39.0°C or more Gasim (2013)7 Age not specified Infrared tympanic  There was no significant difference in thermometers temperature measurement between the two Hospital thermometer types Mercury thermometers  The authors concluded that tympanic temperature measurement was as reliable and accurate as mercury thermometer measurement Evidence-Based Guidelines Emergency Nurses Patients of all ages Non-invasive  The guidelines indicates there is insufficient Association (2015)8 temperature evidence to recommend the use of tympanic Emergency department measurement (including thermometers for adults or patients who are tympanic critically ill or intubated

SUMMARY OF ABSTRACTS Ty mpanic Thermometer Use in Adults in a Hospital Setting 5

First Author (Year) Population and Intervention and Results and Author’s Conclusions Setting Comparator(s) thermometers)  There is no evidence to support the use of tympanic thermometers for patients who are hypothermic

References Summarized Health Technology Assessments No literature identified.

Systematic Reviews and Meta-analyses

1. Niven DJ, Gaudet JE, Laupland KB, Mrklas KJ, Roberts DJ, Stelfox HT. Accuracy of peripheral thermometers for estimating temperature: a systematic review and meta- analysis. Ann Intern Med. 2015 Nov 17;163(10):768-77. PubMed: PM26571241

Tympanic Thermometer as the Comparator

2. Geijer H, Udumyan R, Lohse G, Nilsagard Y. Temperature measurements with a temporal scanner: systematic review and meta-analysis. BMJ Open. 2016 Mar 31;6(3). PubMed: PM27033957

Randomized Controlled Trials

No literature identified.

Non-Randomized Studies

3. Aadal L, Fog L, Pedersen AR. Tympanic ear thermometer assessment of body temperature among patients with cognitive disturbances. An acceptable and ethically desirable alternative? Scand J Caring Sci. 2016 Dec;30(4):766-73. PubMed: PubMed: PM26842943

4. Bijur PE, Shah PD, Esses D. Temperature measurement in the adult emergency department: oral, tympanic membrane and temporal artery temperatures versus rectal temperature. Emerg Med J. 2016 Dec;33(12):843-7. PubMed: PM27334759

5. Dakappa PH, Bhat GK, Bolumbu G, Rao SB, Adappa S, Mahabala C. Comparison of Conventional Mercury Thermometer and Continuous TherCom(®) Temperature Recording in Hospitalized Patients. J Clin Diagn Res. 2016 Sep;10(9):OC43-OC46. PubMed: PM27790493

6. Yang WC, Kuo HT, Lin CH, Wu KH, Chang YJ, Chen CY, et al. Tympanic temperature versus temporal temperature in patients with pyrexia and chills. Medicine (Baltimore). 2016 Nov;95(44):e5267. PubMed: PM27858893

SUMMARY OF ABSTRACTS Ty mpanic Thermometer Use in Adults in a Hospital Setting 6

7. Gasim GI, Musa IR, Abdien MT, Adam I. Accuracy of tympanic temperature measurement using an infrared tympanic membrane thermometer. BMC Res Notes. 2013 May 10;6:194. PubMed: PM23663659

Guidelines and Recommendations

8. Emergency Nurses Association. Clinical practice guideline: non-invasive temperature measurement [Internet]. Des Plaines (IL): The Association; 2015. [cited 2018 Feb 5]. Available from: https://www.ena.org/docs/default-source/resource-library/practice- resources/cpg/temperaturemeasurementcpg.pdf?sfvrsn=8853209f_8 See: Description of Decision Options/Interventions and the Level of Recommendation, page 10

SUMMARY OF ABSTRACTS Ty mpanic Thermometer Use in Adults in a Hospital Setting 7

Appendix — Further Information Previous CADTH Reports

9. Canadian Agency for Drugs and Technologies in Health. Non-contact thermometers for detecting fever: a review of clinical effectiveness [Internet]. Ottawa: The Agency; 2014 Nov 20. (Rapid response report: summary with critical appraisal). [cited 2018 Feb 5]. Available from: https://www.cadth.ca/sites/default/files/pdf/htis/nov- 2014/RC0610%20Non-contact%20Thermometers%20Final.pdf

10. Canadian Agency for Drugs and Technologies in Health. Temporal versus tympanic thermometers: ease of use and cost-effectiveness [Internet]. Ottawa: The Agency; 2011 Mar 2. (Rapid response report: summary of abstracts). [cited 2018 Feb 5]. Available from: https://www.cadth.ca/sites/default/files/pdf/htis/march- 2011/K0325_Thermometers_final.pdf

11. Canadian Agency for Drugs and Technologies in Health. Tympanic and temporal thermometers in long-term care and acute care: clinical effectiveness and ease of use [Internet]. Ottawa: The Agency; 2009 Oct 30. (Rapid response report). [cited 2018 Feb 5]. Available from: https://www.cadth.ca/sites/default/files/pdf/htis- L1/J0335%20Thermometers%20final.pdf

Economic Evaluations

12. Hayes K, Shepard A, Cesarec A, Likic R. Cost minimisation analysis of thermometry in two different hospital systems. Postgrad Med J. 2017 Oct;93(1104):603-6. PubMed: PM28100807

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