Non-contact infrared versus axillary and tympanic thermometers in children attending primary care: a mixed-methods study of accuracy and acceptability

Gail Hayward; Jan Y. Verbakel; Fatene Abakar Ismail; George Edwards; Kay Wang; Susannah Fleming; Gea A. Holtman; Margaret Glogowska; Elizabeth Morris; Kathryn Curtis; Ann van den Bruel

doi:10.3399/bjgp20X708845

Non-contact infrared versus axillary and tympanic thermometers in children attending primary care: a mixed-methods study of accuracy and acceptability

Gail Hayward^*, Jan Y. Verbakel, Fatene Abakar Ismail, George Edwards, Kay Wang, Susannah Fleming, Gea A. Holtman, Margaret Glogowska, Elizabeth Morris, Kathryn Curtis, Ann van den Bruel

^*Corresponding author for this work

Research output: Contribution to journal › Article › Academic › peer-review

5 Citations (Scopus)

Abstract

Background

Guidelines recommend measuring temperature in children presenting with fever using electronic axillary or tympanic thermometers. Non-contact thermometry offers advantages, yet has not been tested against recommended methods in primary care.

Aim

To compare two different non-contact infrared thermometers (NCITs) to axillary and tympanic thermometers in children aged

Design and setting

Method comparison study with nested qualitative component.

Method

Temperature measurements were taken with electronic axillary (Welch Allyn SureTemp (R)], electronic tympanic [Braun Thermoscan (R)], NCIT Thermofocus (R) 0803. and NCIT Firheatth Forehead. Parents rated acceptability and discomfort. Qualitative interviews explored parents' experiences of the thermometers.

Results

In total 401 children were recruited (median age 1.6 years, 50.62% male). Mean difference between the Thermofocus NCIT and axillary thermometer was 0.14 degrees C (95% confidence interval (CI) = 0.21 to -0.06 degrees C); lower limit of agreement was -1.57 degrees C (95% CI = -1.69 to -1.44 degrees C) and upper limit 1.29 degrees C (95% CI = 1.16 to 1.42 degrees C). A second NCIT (Firhealth) had similar levels of agreement; however, the limits of agreement between tympanic and axillary thermometers were also wide. Parents expressed a preference for the practicality and comfort of NCITs, and were mostly negative about their child's experience of axillary thermometers. But there was willingness to adopt which, was medically recommended.

Conclusion

In a primary care paediatric population, temperature measurements with NCITs varied by >1 degrees C compared with axillary and tympanic approaches. But there was also poor agreement between tympanic and axillary thermometers. Since clinical guidelines often rely on specific fever thresholds, clinicians should interpret penpheral thermometer readings with caution and in the context of a holistic assessment of the child.

Original language	English
Pages (from-to)	E236-E244
Number of pages	9
Journal	British Journal of General Practice
Volume	70
Issue number	693
DOIs	https://doi.org/10.3399/bjgp20X708845
Publication status	Published - Apr-2020

Keywords

acute disease
child
fever
primary health care
thermometers
RECTAL THERMOMETRY
CLINICAL ACCURACY
EAR THERMOMETRY
TEMPERATURE
FEVER
SKIN
PARENTS

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Non-contact infrared versus axillary and tympanic thermometers in children attending primary care
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Hayward, G., Verbakel, J. Y., Ismail, F. A., Edwards, G., Wang, K., Fleming, S., Holtman, G. A., Glogowska, M., Morris, E., Curtis, K., & van den Bruel, A. (2020). Non-contact infrared versus axillary and tympanic thermometers in children attending primary care: a mixed-methods study of accuracy and acceptability. British Journal of General Practice, 70(693), E236-E244. https://doi.org/10.3399/bjgp20X708845

Hayward, Gail ; Verbakel, Jan Y. ; Ismail, Fatene Abakar ; Edwards, George ; Wang, Kay ; Fleming, Susannah ; Holtman, Gea A. ; Glogowska, Margaret ; Morris, Elizabeth ; Curtis, Kathryn ; van den Bruel, Ann. / Non-contact infrared versus axillary and tympanic thermometers in children attending primary care : a mixed-methods study of accuracy and acceptability. In: British Journal of General Practice. 2020 ; Vol. 70, No. 693. pp. E236-E244.

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title = "Non-contact infrared versus axillary and tympanic thermometers in children attending primary care: a mixed-methods study of accuracy and acceptability",

abstract = "BackgroundGuidelines recommend measuring temperature in children presenting with fever using electronic axillary or tympanic thermometers. Non-contact thermometry offers advantages, yet has not been tested against recommended methods in primary care.AimTo compare two different non-contact infrared thermometers (NCITs) to axillary and tympanic thermometers in children agedDesign and settingMethod comparison study with nested qualitative component.MethodTemperature measurements were taken with electronic axillary (Welch Allyn SureTemp (R)], electronic tympanic [Braun Thermoscan (R)], NCIT Thermofocus (R) 0803. and NCIT Firheatth Forehead. Parents rated acceptability and discomfort. Qualitative interviews explored parents' experiences of the thermometers.ResultsIn total 401 children were recruited (median age 1.6 years, 50.62% male). Mean difference between the Thermofocus NCIT and axillary thermometer was 0.14 degrees C (95% confidence interval (CI) = 0.21 to -0.06 degrees C); lower limit of agreement was -1.57 degrees C (95% CI = -1.69 to -1.44 degrees C) and upper limit 1.29 degrees C (95% CI = 1.16 to 1.42 degrees C). A second NCIT (Firhealth) had similar levels of agreement; however, the limits of agreement between tympanic and axillary thermometers were also wide. Parents expressed a preference for the practicality and comfort of NCITs, and were mostly negative about their child's experience of axillary thermometers. But there was willingness to adopt which, was medically recommended.ConclusionIn a primary care paediatric population, temperature measurements with NCITs varied by >1 degrees C compared with axillary and tympanic approaches. But there was also poor agreement between tympanic and axillary thermometers. Since clinical guidelines often rely on specific fever thresholds, clinicians should interpret penpheral thermometer readings with caution and in the context of a holistic assessment of the child.",

keywords = "acute disease, child, fever, primary health care, thermometers, RECTAL THERMOMETRY, CLINICAL ACCURACY, EAR THERMOMETRY, TEMPERATURE, FEVER, SKIN, PARENTS",

author = "Gail Hayward and Verbakel, {Jan Y.} and Ismail, {Fatene Abakar} and George Edwards and Kay Wang and Susannah Fleming and Holtman, {Gea A.} and Margaret Glogowska and Elizabeth Morris and Kathryn Curtis and {van den Bruel}, Ann",

year = "2020",

month = apr,

doi = "10.3399/bjgp20X708845",

language = "English",

volume = "70",

pages = "E236--E244",

journal = "British Journal of General Practice",

issn = "0960-1643",

publisher = "ROYAL COLL GENERAL PRACTITIONERS",

number = "693",

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Hayward, G, Verbakel, JY, Ismail, FA, Edwards, G, Wang, K, Fleming, S, Holtman, GA, Glogowska, M, Morris, E, Curtis, K & van den Bruel, A 2020, 'Non-contact infrared versus axillary and tympanic thermometers in children attending primary care: a mixed-methods study of accuracy and acceptability', British Journal of General Practice, vol. 70, no. 693, pp. E236-E244. https://doi.org/10.3399/bjgp20X708845

Non-contact infrared versus axillary and tympanic thermometers in children attending primary care : a mixed-methods study of accuracy and acceptability. / Hayward, Gail; Verbakel, Jan Y.; Ismail, Fatene Abakar; Edwards, George; Wang, Kay; Fleming, Susannah; Holtman, Gea A.; Glogowska, Margaret; Morris, Elizabeth; Curtis, Kathryn; van den Bruel, Ann.

In: British Journal of General Practice, Vol. 70, No. 693, 04.2020, p. E236-E244.

Research output: Contribution to journal › Article › Academic › peer-review

TY - JOUR

T1 - Non-contact infrared versus axillary and tympanic thermometers in children attending primary care

T2 - a mixed-methods study of accuracy and acceptability

AU - Hayward, Gail

AU - Verbakel, Jan Y.

AU - Ismail, Fatene Abakar

AU - Edwards, George

AU - Wang, Kay

AU - Fleming, Susannah

AU - Holtman, Gea A.

AU - Glogowska, Margaret

AU - Morris, Elizabeth

AU - Curtis, Kathryn

AU - van den Bruel, Ann

PY - 2020/4

Y1 - 2020/4

N2 - BackgroundGuidelines recommend measuring temperature in children presenting with fever using electronic axillary or tympanic thermometers. Non-contact thermometry offers advantages, yet has not been tested against recommended methods in primary care.AimTo compare two different non-contact infrared thermometers (NCITs) to axillary and tympanic thermometers in children agedDesign and settingMethod comparison study with nested qualitative component.MethodTemperature measurements were taken with electronic axillary (Welch Allyn SureTemp (R)], electronic tympanic [Braun Thermoscan (R)], NCIT Thermofocus (R) 0803. and NCIT Firheatth Forehead. Parents rated acceptability and discomfort. Qualitative interviews explored parents' experiences of the thermometers.ResultsIn total 401 children were recruited (median age 1.6 years, 50.62% male). Mean difference between the Thermofocus NCIT and axillary thermometer was 0.14 degrees C (95% confidence interval (CI) = 0.21 to -0.06 degrees C); lower limit of agreement was -1.57 degrees C (95% CI = -1.69 to -1.44 degrees C) and upper limit 1.29 degrees C (95% CI = 1.16 to 1.42 degrees C). A second NCIT (Firhealth) had similar levels of agreement; however, the limits of agreement between tympanic and axillary thermometers were also wide. Parents expressed a preference for the practicality and comfort of NCITs, and were mostly negative about their child's experience of axillary thermometers. But there was willingness to adopt which, was medically recommended.ConclusionIn a primary care paediatric population, temperature measurements with NCITs varied by >1 degrees C compared with axillary and tympanic approaches. But there was also poor agreement between tympanic and axillary thermometers. Since clinical guidelines often rely on specific fever thresholds, clinicians should interpret penpheral thermometer readings with caution and in the context of a holistic assessment of the child.

AB - BackgroundGuidelines recommend measuring temperature in children presenting with fever using electronic axillary or tympanic thermometers. Non-contact thermometry offers advantages, yet has not been tested against recommended methods in primary care.AimTo compare two different non-contact infrared thermometers (NCITs) to axillary and tympanic thermometers in children agedDesign and settingMethod comparison study with nested qualitative component.MethodTemperature measurements were taken with electronic axillary (Welch Allyn SureTemp (R)], electronic tympanic [Braun Thermoscan (R)], NCIT Thermofocus (R) 0803. and NCIT Firheatth Forehead. Parents rated acceptability and discomfort. Qualitative interviews explored parents' experiences of the thermometers.ResultsIn total 401 children were recruited (median age 1.6 years, 50.62% male). Mean difference between the Thermofocus NCIT and axillary thermometer was 0.14 degrees C (95% confidence interval (CI) = 0.21 to -0.06 degrees C); lower limit of agreement was -1.57 degrees C (95% CI = -1.69 to -1.44 degrees C) and upper limit 1.29 degrees C (95% CI = 1.16 to 1.42 degrees C). A second NCIT (Firhealth) had similar levels of agreement; however, the limits of agreement between tympanic and axillary thermometers were also wide. Parents expressed a preference for the practicality and comfort of NCITs, and were mostly negative about their child's experience of axillary thermometers. But there was willingness to adopt which, was medically recommended.ConclusionIn a primary care paediatric population, temperature measurements with NCITs varied by >1 degrees C compared with axillary and tympanic approaches. But there was also poor agreement between tympanic and axillary thermometers. Since clinical guidelines often rely on specific fever thresholds, clinicians should interpret penpheral thermometer readings with caution and in the context of a holistic assessment of the child.

KW - acute disease

KW - child

KW - fever

KW - primary health care

KW - thermometers

KW - RECTAL THERMOMETRY

KW - CLINICAL ACCURACY

KW - EAR THERMOMETRY

KW - TEMPERATURE

KW - FEVER

KW - SKIN

KW - PARENTS

U2 - 10.3399/bjgp20X708845

DO - 10.3399/bjgp20X708845

M3 - Article

VL - 70

SP - E236-E244

JO - British Journal of General Practice

JF - British Journal of General Practice

SN - 0960-1643

IS - 693

ER -