Review Article
In a systematic review, infrared ear thermometry for fever diagnosis in children finds poor sensitivity

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Abstract

Background and Objectives

To investigate sensitivity and specificity of infrared ear thermometry compared to rectal thermometry to detect fever in children.

Methods

Systematic review of studies comparing rectal and infrared ear temperatures in children.

Results

Sensitivity and specificity estimates were highly heterogeneous, and displayed an inverse relationship suggestive of a threshold effect, due in part to the different offsets used to obtain adjusted tympanic temperatures depending on the ear thermometer mode. To account for this threshold effect, results from each study were summarized as a diagnostic odds ratio (DOR). These varied extensively across studies, suggesting that heterogeneity between study estimates is not fully explained by the threshold effect. Pooled estimates of sensitivity and specificity from random effects models were 63.7% (95% CI 55.6%, 71.8%) and 95.2% (95% CI 93.5%, 96.9%), respectively.

Conclusion

Pooled estimates of measures of diagnostic accuracy from these studies suggest that infrared ear thermometry would fail to diagnose fever in three or four out of every 10 febrile children (with fever defined by a rectal temperature of 38°C or above). These findings support our previous concerns about the use of infrared ear thermometers in situations where a failure to detect fever has serious implications.

Introduction

We previously undertook a systematic review of studies where rectal and infrared ear temperatures were compared in children [1]. Despite a relatively small pooled mean temperature difference (0.29°C), the wide 95% limits of agreement (−0.74 to 1.32°C) suggested that infrared ear thermometry should not be used as an approximation for rectal thermometry. Having investigated agreement, a necessary first step in any method comparison study, an important clinical question is how many cases of true fever would be missed using ear thermometry. The aim of this study was to determine diagnostic accuracy by examining the sensitivities and specificities from the studies used in our previous work, and to investigate the effect of thermometer mode on these measures of accuracy.

Section snippets

Methods

Studies that compared temperatures taken at the ear (using infrared devices) and rectum (using either an electronic, mercury, or indwelling thermocouple device) in children aged between 0 and 18 were included in the original review, excluding those with hypothermia (rectal temperature <35.0°C) and preterm infants (born at <37 weeks' gestation) [1]. We used rectal temperature as a reference measure, as it is a well-established method of measuring temperature in children [2]. Of the 44 original

Results

Twenty-three of 44 eligible studies identified in the original review provided relevant data for inclusion in this review, giving a total of 4,098 children (69%). The majority of studies defined 38°C as the cutoff for fever for both rectal and tympanic temperatures. However in one study, a cutoff of 38.1°C was taken for rectal temperatures and 37.6°C for tympanic temperatures, while in a second, a cutoff of 37.9°C was used for both temperatures.

Sensitivities ranged from 0 to 100% [unweighted

Discussion

We have extended the analysis of our original systematic review [1] by examining sensitivities and specificities of infrared ear thermometers for detecting fever in children, as determined by rectal temperature. We have assumed that the results from the 23 studies that we were able to include in this analysis are representative of the 44 included in the original review.

The sensitivity and specificity estimates varied extensively in these studies. One reason for this heterogeneity was the

Contributors

Susanna Dodd carried out data extraction and meta-analysis, and drafted and revised the report. Rosalind Smyth conceived the idea for the study and Paula Williamson conceived the idea for this further analysis. Jean Craig obtained IPD and assisted with data extraction. Paula Williamson and Gill Lancaster gave advice on the approach to the analysis and Rosalind Smyth advised on the interpretation of the results. All authors commented on the final draft of the report.

Conflict of interest statement

None declared.

References (9)

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