Accuracy of tympanic temperature readings in children under 6 years of age

Lanham, D. M., Walker, B., Klocke, E., & Jennings, M. (1999). Accuracy of tympanic temperature readings in children under 6 years of age. Pediatric Nursing, 25(1), 39-42. Retrieved from http://search.proquest.com/docview/199517851?accountid=33262 View this document in ProQuest Abstract (summary) Lanham et al determine the correlation and extent of agreement between rectal temperature readings obtained by electronic thermometer and ear-based temperature readings obtained by infrared tympanic thermometry, and determine the accuracy of detecting fever in children under 6 years of age. Purpose: Infrared tympanic thermometry (ITT) is increasingly used as a convenient, noninvasive assessment method for febrile children. However, the accuracy of IT for children has been questioned, particularly in relation to specificity and sensitivity. This study was designed to (a) determine the correlation and extent of agreement between rectal temperature (RT) readings obtained by electronic thermometer and ear-- based temperature readings obtained by ITT, and (b) determine the accuracy of detecting fever in children under 6 years of age. Methods: This correlational study used a sample of 241 paired ear and rectal temperatures obtained in the emergency department (ED) of a 920-bed regional hospital. All children under the age of 6 years who routinely received a rectal temperature measurement were eligible to participate. According to the ED protocol, rectal temperatures were obtained on all patients less than 3 years or patients 3-6 years that presented with a complaint of fever. For the study, tympanic measurements were also taken. Results: Correlation between rectal and tympanic temperature readings was statistically significant (r = 0.84, p < .001). The mean difference between rectal and tympanic temperatures was -0.60 deg C. Threshold-a4lusted accuracy in screening for fever was determined by sensitivity (80%), specificity (85%), positive predictive value (87%), and negative predictive value (85%).

Reaction:
Sensitivity, specificity, positive predictive value, and negative predictive value are unacceptably low and the number of children with fever who would be missed by screening with a tympanic thermometer is unacceptable. Findings of this study do not support the use of tympanic thermometers to detect fever in children under 6 years of age. Accurate determination of temperature is key in the diagnosis and treatment of febrile illnesses in the pediatric population. Temperatures can be measured at various sites to obtain both shell and core temperature readings with core readings being most reflective of true body temperature. Rectal and tympanic readings are considered to be core temperatures, and axillary and oral readings reflect shell temperatures. Rectal temperatures (RTs) measured by glass mercury and/or electronic thermometers have traditionally been accepted as the gold standard for making clinical management decisions in infants and small children as they reflect a core temperature (Brennan et al., 1995; Erickson & Woo, 1994; Pontious et al., 1994; Rogers et al., 1991). Recent studies have suggested that infrared tympanic thermometers (ITT) may be a safe, convenient, noninvasive method for measuring core temperatures (Erickson & Woo, 1994; Pontious et al., 1994; Stewart & Webster, 1992). However, inconsistencies regarding the accuracy of ITT measurements in determining fever in infants and small children have been reported in the literature

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Sulapas, Arjon Clint R.

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