Temporal artery and non-contact infra-red thermometers: is there sufficient evidence to support their use in secondary care?

Abstract

Background and Objective Accurate measurement of body temperature is a key part of patient observations and can influence important decisions regarding tests, diagnosis and treatment. For routine measurements in hospitals, non-invasive thermometers such as tympanic infra-red ear thermometers are very widely used even though non-invasive thermometers are not as accurate as core thermometry. However, there are known issues regarding the accuracy of these thermometers due to user errors including dirty probe covers and not straightening the ear canal. We were therefore keen to understand if there was evidence to support the use of alternative non-tympanic, non-invasive thermometer that could be easily and widely deployed across Nottingham University Hospitals NHS Trust. Material and Methods A search of the published literature via the NICE HDAS was undertaken to identify the evidence on the use of temporal artery (TAT) or non-contact infra-red forehead (NCIT) thermometers compared to a core body temperature thermometer in a clinical setting. The relevant literature was identified, appraised and summarised. Results 15 papers described the use of TAT but only 5 reported results that were considered within clinically acceptable limits of which 2 included febrile patients. Nine of the 10 studies where TAT was considered not to be within acceptable limits included febrile patients. For the NCIT, 3 studies were identified but only 1 reported results within acceptable limits and this did not include febrile patients. Conclusion A review of the literature for both TAT and NCIT has indicated that neither is currently suitable as a replacement for tympanic IR ear thermometers in clinical practice. In particular, the evidence suggests that they are not acceptable methods for detecting temperatures outside the normothermic range and do not detect fever accurately. In addition, the potential for user error with TAT is considered unacceptable.