Selection of the Most Accurate Thermometer Devices for Clinical Practice: Part 1

Meta-Analysis of the Accuracy of Non-Core Thermometer Devices Compared to Core Body Temperature

Nancy A. Ryan-Wenger; Maureen A. Sims; Rebecca A. Patton; Jayme Williamson


Pediatr Nurs. 2018;44(3):116-133. 

In This Article


The inclusion of rectal or other peripheral devices as reference standards for core body temperature were major flaws in the design of four systematic reviews (Duce, 1996; El Radhi & Barry, 2006; Jefferies, Weatherall, Young, & Beasley, 2011; Kiekkas, Sterfaopoulos, Bakalis, Kefaliakos, & Karaikolas, 2016) and six meta-analyses (Craig, Lancaster, Taylor, Williamson, & Smyth, 2002; Craig, Lancaster, Williamson, & Smyth, 2000; Dodd, Lancaster, Craig, Smyth, & Williamson, 2006; Niven et al., 2015; Zhen, Xia, Long, & Pu, 2014; Zhen, Xia, Ya Jun et al., 2014). Core body temperature is defined by experts as "temperature of the blood that bathes the temperature-regulating center of the body, i.e., hypothalamus" (Batra, Saha, & Faridi, 2012, p. 246). The pulmonary artery site is closest to the hypothalamus, but other acceptable core body temperature sites include the distal esophageal, bladder, and nasopharyngeal sites; thus, rectal temperature is not an appropriate reference standard (Robinson, Charlton, Seal, Spady, & Joffres, 1998).

Authors of four meta-analyses concluded that thermometer devices need to be accurate only in certain circumstances (Craig et al., 2000, 2002; Dodd, Lancaster, Craig, Smyth, & Williamson, 2006; Niven et al., 2015). For example, Niven and colleagues (2015) stated that tympanic, temporal, axillary, and oral thermometers should not be used "when accurate measurement of a patient's temperature will influence diagnosis and management" (p. 774), and Dodd and colleagues (2006) suggested that tympanic devices should not be used "when a failure to detect fever has serious consequences" (p. 354). We believe thermometers should be accurate in all situations, including screening, monitoring, diagnosis, and treatment. It became clear from this review that a new meta-analysis of studies that compared temperatures from non-core devices with temperatures from appropriate core body temperature sites was needed.