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.

Purpose

The purpose of this meta-analysis was to review and synthesize research on the accuracy of thermometer devices commonly used in hospitals and clinics, to make recommendations for use in clinical practice. In this meta-analysis, we combined statistical results from several studies to determine which non-core routes and devices provided the most accurate body temperature when compared to core body temperature. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines (Moher et al., 2015) were followed in this report.

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Table 1. Authors, Sample Characteristics, Core and Non-Core Sites, Devices, and Modes Used for Temperature Measurement
Author (Year)	Sample	Core Site and Device		Non-Core Site	Non-Core Device
Al-Mukhaizeem et al. (2002)	N=80 children Age: <18 years (mean=3.8±2.9) Elective dental surgery (normo-thermic, n=78) Appendectomy (febrile, n=2) N=240 observations	Esophageal: Tele-Thermometer, YSI Inc.		Temporal artery (n=80) Rectal-electronic (n=40) Rectal-electronic probe (n=40)	Temporal Scanner LXTA, Exergen Corporation, Boston, MA IVAC 2000, ALARIS Medical Systems, USA Tele-thermometer, YSI Inc., USA (Modes not reported)
Bock et al. (2005)	N=26 adults Age 48 to 81 years Medical patients N=729 observations	Pulmonary artery: Swan-Ganz, Baxter Healthcare Company, Deerfield, IL		Tympanic	Prototype IRT 4000, Braun GmbH, Kronberg im Taunus, Germany (Mode not reported)
Calonder et al. (2012)	N=23 adults Age: 32 to 85 years Gynecological or colorectal surgery N=138 observations	Esophageal: ES400-18 Level Acoustascope, SMITHS Medical, Dublin, OH		Oral-electronic Temporal artery	SureTemp Plus Model 678, Welch Allyn, Skaneeatels Falls, NY TAT 5000, Exergen, Watertown, MA (Modes not reported)
Drake-Brockman, Hegarty, Chambers, & von Ungern-Sternberg (2014)	N=200 children Age: <1 month to 17 years Elective surgery	Nasopharyngeal: Mon-a-ther 400 temperature probe, Covidien, Dublin, Ireland		Tympanic Temporal artery Axillary-electronic	ThermoScan 6021, Braun, Melsungen, Germany TemporalScanner TAT-500, Exergen, Watertown, MA Digital thermometer AMA Services, Perth, Australia (Modes not reported)
Eyelade, Orimadegun, Akinyemi, Tongo, & Akinyinka (2011)	N=36 children Age: 1 month to 14 years (median=48 months) Elective surgery N=575 observations	Dash 4000 Multi-parameter monitor probe, GE Healthcare, NY		Tympanic	ThermoScan, Thermoscan, Inc., San Diego, CA (Mode not reported)
Fallis, Gupton, & Kassum (1994)	N=33 adults Age: 31 to 77 years (mean=63.4) Cardiac surgery	Pulmonary: Swan-Ganz thermistor, Baxter Healthcare, Irvine, CA		Oral-electronic and rectal-electronic	IVAC 2080A, IVAC Corporation, San Diego, CA (Oral: predictive mode; Rectal: monitor mode)
Farnell, Maxwell, Tan, Rhodes, & Philips (2005)	N=25 adults Age: Not reported Adult intensive care unit (ICU) N=153 axillary and N=160 tympanic observations	Pulmonary artery: 744HF75 catheter, Edward Life Sciences, Irvine, CA		Axillary-chemical Tympanic	Tempa.Dot 3M HealthCare, St. Paul, MN Genius First Temp M3000A, Tyco Health Care, Gosport, UK (core mode)
Fulbrook (1997)	N=60 adults Age: 19 to 86 years (mean=63.4±14) ICU N=300 observations/device	Pulmonary artery: Swan-Ganz catheter #93A-831-7.5F, Baxter Edwards Health Care Corporation		Tympanic Axillary-chemical	Diatek 9000 Insta Temp infrared aural thermometer, DIATEK Incorporated, USA (core mode) TempaDOT Ax single-use clinical thermometer, PyMaH Corporation, USA
Furlong et al. (2015)	N=60 adults Mean age=60.8 years Post-cardiac surgery with fever >100.4°F 3 observers	Pulmonary artery: Swan-Ganz VIP, Edwards Lifesciences, Irvine, CA		Temporal artery	Exergen Temporal Artery Thermometer Model 5000 (mode not reported)
Giuliano et al. (2000)	N=72 adults Age: Not stated Critically ill N=812 observations	Pulmonary artery: VIP Swan-Ganz catheter, Baxter HealthCare Corporation, Irvine, CA		Oral-electronic Tympanic #1 Tympanic #2	SureTemp 678, Welch Allyn, San Diego, CA (core mode) First Temp Genius II, Sherwood Medical, Carlsbad, CA (core mode) ThermoScan Ear Pro-1, Thermoscan, Inc., San Diego, CA (core mode)
Harasawa, Kemmotsu, Mayumi, & Kawano (1997)	N=30 adults Mean age=60 years Cardiac surgery N=675 observations	Esophageal: MonaTherm esophageal probe, Mallincrodt Medical, St. Louis, MO		Tympanic	Thermoscan Pro1, Thermoscan, San Diego, CA (Mode not reported)
Harioka et al. (2000)	N=41 adults Mean age=66±10 years Surgical patients N=451 observations/device	Pulmonary artery: Baxter pulmonary catheter, Baxter Inc., Deerfield, IL		Rectal and tympanic	Mon-a-Therm Mallinckrodt Anesthesiology Products, St. Louis, MO (Mode not reported)
Hebbar, Fortenberry, Rogers, Merritt, & Easley (2005)	N=44 children Median age=11.5 months, interquartile range (IQR), 2 to 34 months Pediatric ICU N=75 observations	Pulmonary artery: Pulmonary artery catheter, Arrow International		Temporal artery Axillary and rectal-electronic	TA thermometer LXTA, Exergen Corporation, Watertown, MA (equilibration mode) Digital axillary thermometer, Allegiance Healthcare Corporation, McGaw Park, IL (equilibration mode)
Henker & Coyne (1995)	N=24 adults Age: 23 to 60 years Post-operative cardiac surgical and cardiac medical patients N=168 observations	Pulmonary artery (PA): PA catheter, Edwards (n=23) PA catheter, Arrow (n=1)		Tympanic #1 Tympanic #2 Oral, axillary, and rectal-electronic Oral and axillary-chemical	Core Check, IVAC, San Diego, CA (Mode not reported) First Temp Genius, Intelligent Medical Systems, Carlsbad, CA (Mode not reported) Temp Plus II Model 2080A, IVAC, San Diego, CA (predictive mode) Tempa.Dot disposable thermometers, PyMaH, Somerville, NJ
Khan, Vohra, Paul, Rosin, & Patel (2006)	N=49 adults Age: 39 to 84 years (mean=66±10) Cardiopulmonary bypass surgery N=629 observations	Bladder: Curity Thermistor 400 Series, Tyro Healthcare, Hampshire, United Kingdom		Tympanic Axillary-electronic	Genius First Temp, Sherwood Medical, Crawley, UK IVAC Temp Plus II, Alaris Medical Systems, San Diego, CA (Modes not reported)
Kimberger, Cohen, Illievich, & Lenhardt (2007)	N=70 adults Neurosurgical OR (mean=49±25 years) Neurosurgical ICU (58±19 years) N=280 observations	Bladder: Temperature sensor in urinary catheter, Smiths-Medical, London, United Kingdom		Temporal artery	TemporalScanner TAT-5000, Exergen, Boston, MA (Mode not reported)
Langham et al. (2009)	N=50 adults Age: 18 to 80 years (mean=57±14) Laparoscopic surgery N=250 observations	Bladder: Mon-a-therm Foley-Temp, Mallinckrodt Anesthesiology Products, St. Louis, MO		Temporal artery Tympanic Oral and axillary-electronic	TemporalScanner TAT-5000, Exergen, Boston, MA FirstTemp Genius 3000A, Kendall, Mansfield, MA IVAC TempPlus II 2080A, Cardinal, Dublin, OH (Modes not reported)
Lawson et al. (2007)	N=60 adults Mean age=57±15 years ICU N=180 observations/device	Pulmonary artery: VIP Swan-Ganz catheter, Edwards Life Sciences, Irvine CA		Oral and axillary-electronic Tympanic Temporal artery	SureTemp Plus, model 692, Welch Allyn, Skaneateles Falls, NY (oral: mode not reported; axillary: equilibration mode) Genius Infrared Tympanic Thermometer 3000A, Sherwood Medical, St. Louis, MO (core mode) Exergen Temporal Scanner, Exergen Corp., Watertown, MA (Mode not reported)
Lefrant et al. (2003)	N=42 adults Median age=73 years, IQR=52,75 ICU N=133 observations/device	Pulmonary artery: Pulmonary artery catheter OptiQ SvO₂/CCO, Abbott Laboratories, N. Chicago, IL		Rectal probe-electronic Axillary-electronic	Electronic temperature probe, YSI, Siemens, Sweden BD digital fever thermometer, Becton Dickinson & Company, Franklin Lakes, NJ (Modes not reported)
Mangat, Standley, Prevost, Vasconcelos, & White (2010)	N=61 adults Mean age=66±0.44 years Elective surgery N=183 observations N=1 observer	Nasopharyngeal: Thermistor 400 Series, Mallinckrodt Inc., USA		Tympanic #1 Tympanic #2 Temporal artery	Genius 2 IRTT, Covidien, Hampshire, MA (ear mode) PRO4000 IRTT, Braun, Germany (oral mode) Exergen 5000 Temporal Artery Scanner, Exergen, Watertown, MA (Mode not reported)
Maxton, Justin, & Gillies (2004)	N=19 children Mean age=0.59±0.44 months Open-heart surgery PICU N=247 observations	Pulmonary artery: Specific Mallenckrodt device not reported		Rectal-electronic Tympanic Axillary-electronic	YSI 400 thermometer, YSI Inc., Yellow Springs, OH First Temp Genius thermometer, Sherwood Medical Company, St. Louis, MO B-D digital thermometer, Beckton Dickinson & Company, Franklin Lakes, NJ (Modes not reported)
Moran et al. (2007)	N=110 adults Mean age=64.6±14.9 years ICU patients N=2,165 observations N>2 observers	Bladder (n=92): Bard temperature-sensing urinary catheter, Bard Medical, Covington, GA Pulmonary artery (n=41): Baxter PA catheter, Baxter Healthcare Corporation, Irvine, CA		Tympanic	Sherwood Medical First Temp, Nippon Sherwood Medical Industries, Tokyo, Japan (core mode)
Myny, De Waele, Defloor, Blot, & Colardyn (2005)	N=57 adults Mean age=60±14.9 Medical ICU N=318 observations	Pulmonary artery: Thermodilution Catheter, Baxter HealthCare Corporation, Irvine, CA		Temporal artery Axillary-electronic	Exergen Temporal Scanner LXTA, Exergen Corporation, Boston, MA Digital Classic, Hartmann, Heidenheim, Germany (Modes not reported)
Nimah, Bshesh, Callahan, & Jacobs (2006)	N=36 children Birth to 77 months (mean=20 ±18.6) Pediatric and cardiac intensive care units N=902 observations	Bladder: RSP Foley catheter and 400 Series Thermistor, Respiratory Support Products, Inc.		Axillary-electronic Temporal artery Rectal-electronic Tympanic	Turbo-Temp Digital thermometer, Alaris Medical Systems, San Diego, CA Sensor-Touch temple thermometer, Model HF370, Phillips Electronic North America Corporation Mon-a-therm rectal probe, Mallinckrodt Medical, St. Louis, MO Braun Thermoscan infrared thermometers Model 3020 & 3520, Braun GMBH, Kronberg, Germany (Modes not reported)
Nonose et al. (2012)	N=73 adults Mean age=68±15 years ICU N=1793 observations	Bladder (n=64): Indwelling balloon catheter with thermistor, BARD, Murray Hill, NJ		Axillary-electronic Tympanic	C202 electronic thermometer, Terumo, Tokyo, Japan (Mode not reported) Genius® Tympanic Thermometer, Intelligent Systems, Inc. Carlsbad, CA (core equivalence mode)
Robinson, Charlton, Seal, Spady, & Joffres (1998)	N=18 adults Age: Not reported Patients undergoing cardiac surgery N=228 observations	Pulmonary artery: Swan Ganz 7 French adult thermodilution catheters, Baxter HealthCare Corporation, Irvine, CA		Tympanic #1 Tympanic #2 Axillary and rectal-electronic	Core-Check Tympanic Thermometer, IVAC Inc., San Diego, CA (core equivalence mode) Genius Tympanic Thermometer, Intelligent Medical Systems, Inc., Carlsbad, CA (tympanic mode) Hi-Lo Temp probes, Mallinckrodt Critical Care, St. Louis, MO (mode not optional)
Rotello, Crawford, & Terndrup (1996)	N=20 adults Age: 18 to 70 years (mean=55 ±12) ICU N=240 observations	Pulmonary artery: 7.5 French Swan-Ganz Thermistor, Baxter HealthCare Corporation, Irvine, CA		Tympanic #1 Tympanic #2 Tympanic #3 Rectal-electronic	Model HM-1 Tympanic* (oral equivalent mode) Model PRO-1 Tympanic* (equal mode) Model PRO-LT Tympanic* (equal mode) *All tympanic thermometers from Thermoscan, San Diego, CA Electronic predictive rectal thermometer Diatek, San Diego, CA (monitor mode)
Rubia-Rubia, Arias, Sierra, & Aguirre-Jaime (2011)	N=201 adults Mean age=59+10 Adults ICU N=13 adults N=113 observations 37 to 86 years old (mean=56.8+56.8) Medical ICU	Pulmonary artery: Device not reported		Axillary – chemical Axillary – electronic (digital probe) Axillary – electronic (compact digital) Tympanic (2 types) Temporal artery	Axillary, temporal, tympanic thermometer devices not reported* Tympanic thermometers (core equivalence mode)
Sahin et al. (2012)	N=60 children Age: 1 month to 4 years (mean=1.84 ±1.7) Abdominal surgery N=420 observations	Nasopharyngeal: GE Datex-Ohmeda S/5 device, Datex-Ohmeda, Inc., Madison, WI		Temporal artery	Temporal-Plus Med Infrared, Model PM 1–802, PlusMed, Istanbul, Turkey (Mode not reported)
Schmitz, Bair, Falk, & Levine (1995)	N=13 adults Age: 37 to 86 years (mean=56.8±14.4) Medical ICU N=113 observations	Pulmonary artery: Edwards Swan-Ganz, 93A-131 H-7F, Baxter HealthCare Corporation, Irvine, CA		Tympanic Rectal-electronic probe Oral and axillary-electronic	First-Temp, model 2000A, Intelligent Medical Systems, Carlsbad, CA (core mode) Mon-a-Therm Model 6500, Mon-a-Therm, Inc., St. Louis, MO (Mode not reported) Model 600 Diatek Inc., San Diego, CA (predictive mode)
Stavem, Saxholm, & Smith-Erichson (1997)	N=16 adults Age: ≥18 years ICU N=66 observations	Pulmonary artery: Ohmeda Criticath, Model SP5107, Vigo Spectramed, Swindon, UK		Rectal electronic Tympanic	Portex probe, 400 series, Kent, UK (Mode not reported FirstTemp 2000A, Intelligent Medical Systems, Carlsbad, CA (core mode)
Stelfox et al. (2010)	N=14 adults Age: 19 to 74 years (mean=51±18) Medical-surgical ICU N=760 observations	Bladder: Level 1 Foley catheter temperature sensor, Smiths Group PLC, Rockland, MA		Temporal artery	TemporalScanner TAT-5000, Exergen Corporation, Watertown, MA (Mode not reported)
Suleman, Doufas, Akça, Ducharme, & Sessler (2002)	N=16 adults Age: 36 to 83 years N=15 children Age: 9 days-13 years Post-operative cardiac surgery	Pulmonary artery: Adults Bladder – Children Devices not reported	Temporal artery		Sensor-Touch temple thermometer, Phillips Inc., Rotterdam, The Netherlands (Mode not reported)
White, Baird, & Anderson (1994)	N=19 adults Age: 51 to 75 years Surgical patients N=95 observations N=2 observers	Pulmonary artery: Baxter-Edwards, Irvine CA (n=10); Abbott, Mountain View, CA (n=9)	Tympanic #1 Tympanic #2		FirstTemp FirstTemp (brands not reported; modes not reported)

Table 2. Tests of Precision and Heterogeneity of 6 Non-Core Thermometer Devices Based on Variation of Temperatures Between and Within Studies
Device	Precision				Extent of Heterogeneity			Impact of Heterogeneity
Device	df	ES͞x	SE	z	χ²	CV	Q	Systematic Error	Random Sampling Error I ²
Oral electronic	6	0.369	0.06	6.2*	-10,254	12.59	0%	0 %	100%
Rectal electronic	13	0.414	0.05	8.5*	-29,630	21.03	0%	0%	100%
Axillary chemical	4	0.434	0.06	7.9*	-25,744	9.48	0%	0%	100%
Axillary electronic	14	0.556	0.03	18.8*	-386,243	23.68	0%	0%	100%
Tympanic	38	0.558	0.02	24.5*	-100,758	41.34	0%	0%	100%
Temporal artery	15	0.732	0.03	23.6*	-562,736	25.00	0%	0%	100%

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

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