Daniel J. Niven, MD, MSc; Jonathan E. Gaudet, MD, MSc; Kevin B. Laupland, MD, MSc; Kelly J. Mrklas, MSc; Derek J. Roberts, MD, PhD; Henry Thomas Stelfox, MD, PhD
Acknowledgment: The authors thank Drs. Juan Posadas, Wataru Inoue, Byoungchun Lee, and Ebba Kurz for their help in translating, screening, and extracting data from relevant non–English-language articles; Dr. Sharon Straus for her comments on an earlier version of this manuscript; and the editors and reviewers for their suggestions that strengthened this manuscript.
Financial Support: This study did not receive any specific funding from any organization. Drs. Niven and Roberts are funded through Clinician Fellowship Awards from Alberta Innovates–Health Solutions and Knowledge Translation Canada Student Fellowship and Training Program grants. Dr. Stelfox is supported by a New Investigator Award from the Canadian Institutes of Health Research and a Population Health Investigator Award from Alberta Innovates–Health Solutions.
Disclosures: Authors have disclosed no conflicts of interest. Forms can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M15-1150.
Editors' Disclosures: Christine Laine, MD, MPH, Editor in Chief, reports that she has no financial relationships or interests to disclose. Darren B. Taichman, MD, PhD, Executive Deputy Editor, reports that he has no financial relationships or interests to disclose. Cynthia D. Mulrow, MD, MSc, Senior Deputy Editor, reports that she has no relationships or interests to disclose. Deborah Cotton, MD, MPH, Deputy Editor, reports that she has no financial relationships or interest to disclose. Jaya K. Rao, MD, MHS, Deputy Editor, reports that she has stock holdings/options in Eli Lilly and Pfizer. Sankey V. Williams, MD, Deputy Editor, reports that he has no financial relationships or interests to disclose. Catharine B. Stack, PhD, MS, Deputy Editor for Statistics, reports that she has stock holdings in Pfizer.
Reproducible Research Statement:Study protocol, statistical code, and data set: Available to approved persons by written agreements (Dr. Niven; e-mail, Daniel.niven@alberta healthservices.ca).
Requests for Single Reprints: Daniel J. Niven, MD, Department of Critical Care Medicine, Peter Lougheed Centre, 3500 26th Avenue Northeast, Calgary, Alberta T1Y 6J4, Canada; e-mail, Daniel.email@example.com.
Current Author Addresses: Drs. Niven and Gaudet: Department of Critical Care Medicine, Peter Lougheed Centre, 3500 26th Avenue Northeast, Calgary, Alberta T1Y 6J4, Canada.
Dr. Laupland: Department of Medicine, Royal Inland Hospital, 311 Columbia Street, Kamloops, British Columbia V2C 2T1, Canada.
Ms. Mrklas: Foothills Medical Centre, South Tower, 1403 29th Street Northwest, Calgary, Alberta T2N 2T9, Canada.
Dr. Roberts: Department of Critical Care Medicine, Foothills Medical Centre, 3134 Hospital Drive Northwest, Calgary, Alberta T2N 5A1, Canada.
Dr. Stelfox: Teaching, Research, and Wellness Building, University of Calgary, 3280 Hospital Drive Northwest, Calgary, Alberta T2N 4Z6, Canada.
Author Contributions: Conception and design: D.J. Niven, K.B. Laupland, D.J. Roberts, H.T. Stelfox.
Analysis and interpretation of the data: D.J. Niven, K.B. Laupland, K.J. Mrklas, D.J. Roberts.
Drafting of the article: D.J. Niven, D.J. Roberts, H.T. Stelfox.
Critical revision of the article for important intellectual content: D.J. Niven, J.E. Gaudet, K.B. Laupland, K.J. Mrklas, D.J. Roberts, H.T. Stelfox.
Final approval of the article: D.J. Niven, J.E. Gaudet, K.B. Laupland, K.J. Mrklas, D.J. Roberts, H.T. Stelfox.
Statistical expertise: D.J. Niven, D.J. Roberts, H.T. Stelfox.
Administrative, technical, or logistic support: H.T. Stelfox.
Collection and assembly of data: D.J. Niven, J.E. Gaudet, K.J. Mrklas.
Niven DJ, Gaudet JE, Laupland KB, Mrklas KJ, Roberts DJ, Stelfox HT. Accuracy of Peripheral Thermometers for Estimating Temperature: A Systematic Review and Meta-analysis. Ann Intern Med. 2015;163:768-777. doi: 10.7326/M15-1150
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Published: Ann Intern Med. 2015;163(10):768-777.
Body temperature is commonly used to screen patients for infectious diseases, establish diagnoses, monitor therapy, and guide management decisions.
To determine the accuracy of peripheral thermometers for estimating core body temperature in adults and children.
MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, and CINAHL Plus from inception to July 2015.
Prospective studies comparing the accuracy of peripheral (tympanic membrane, temporal artery, axillary, or oral) thermometers with central (pulmonary artery catheter, urinary bladder, esophageal, or rectal) thermometers.
2 reviewers extracted data on study characteristics, methods, and outcomes and assessed the quality of individual studies.
75 studies (8682 patients) were included. Most studies were at high or unclear risk of patient selection bias (74%) or index test bias (67%). Compared with central thermometers, peripheral thermometers had pooled 95% limits of agreement (random-effects meta-analysis) outside the predefined clinically acceptable range (± 0.5 °C), especially among patients with fever (−1.44 °C to 1.46 °C for adults; −1.49 °C to 0.43 °C for children) and hypothermia (−2.07 °C to 1.90 °C for adults; no data for children). For detection of fever (bivariate random-effects meta-analysis), sensitivity was low (64% [95% CI, 55% to 72%]; I2 = 95.7%; P < 0.001) but specificity was high (96% [CI, 93% to 97%]; I2 = 96.3%; P < 0.001). Only 1 study reported sensitivity and specificity for the detection of hypothermia.
High-quality data for some temperature measurement techniques are limited. Pooled data are associated with interstudy heterogeneity that is not fully explained by stratified and metaregression analyses.
Peripheral thermometers do not have clinically acceptable accuracy and should not be used when accurate measurement of body temperature will influence clinical decisions.
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