TITLE Thermometer Use for Febrile Pediatric Patients A

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2 What is the comparative accuracy of temporal artery tympanic rectal or axilla. thermometers in febrile pediatric patients two years of age and older and in patients. younger than two years of age, 3 What are the evidence based guidelines associated with the use of temporal artery. tympanic rectal or axilla thermometers in febrile pediatric patients two years of age and. older and in patients younger than two years of age. KEY FINDINGS, Limited evidence showed that for febrile children either younger or older than 2 years old digital. temporal artery thermometry correlates well with digital rectal thermometry or traditional rectal. glass mercury thermometry for detecting fever and is more comfortable offers significant. savings in nursing time and could replace rectal thermometry in a busy emergency room. setting In sick neonates and febrile children up to 2 years old infrared skin contact temporal. artery thermometer had low sensitivity and specificity for detecting fever 38 C and a large. difference in measurements and low correlation with the standard comparators traditional. axillary glass mercury thermometer or traditional rectal digital thermometer while the infrared. tympanic thermometer or digital axillary thermometer had smaller difference and higher. correlation with the standard comparators The infrared tympanic thermometry also showed. reliability with measurements similar to digital rectal thermometry in both febrile and afebrile. children up to 2 years old and the effect extended to children up to 18 years old. There was no evidence identified on the comparative clinical effectiveness or evidence based. guidelines on the use of temporal artery thermometers with tympanic rectal or axilla. thermometers in febrile pediatric patients two years of age and older and in patients younger. than two years of age,Literature Search Strategy, A limited literature search was conducted on key resources including PubMed The Cochrane. Library University of York Centre for Reviews and Dissemination CRD databases Canadian. and major international health technology agencies as well as a focused Internet search For. research question 3 a methodological filter was applied to limit retrieval to guidelines For all. other research questions no filters were applied to limit the retrieval by study type Where. possible retrieval was limited to the human population The search was also limited to English. language documents published between January 1 2011 and February 18 2016. Selection Criteria and Methods, One reviewer screened the titles and abstracts of the retrieved publications and examined the. full text publications for the final article selection Selection criteria are outlined in Table 1. Pediatric Thermometers 2,Table 1 Selection Criteria.
Population Febrile pediatric patients 2 and 2 years of age presenting to the. emergency room operating room pediatric units or clinics including. hospital and community,Intervention Temporal artery thermometer. Comparator Tympanic thermometer,Rectal thermometer. Axilla thermometer,Outcomes Comparative clinical effectiveness. Accuracy in patients 2 and 2 years of age, Guidelines use of all identified thermometer types in patients 2 and. 2 years of age, Study Designs Health technology assessments HTA systematic reviews SR.
meta analyses MA randomized controlled trials RCTs non RCTs. and evidence based guidelines,Exclusion Criteria, Articles were excluded if they did not meet the selection criteria in Table 1 if the age groups. were mixed and not distinctly divided into 2 or 2 years old if they were published prior to. January 2011 if they were duplicate publications of the same study or if they were referenced. in a selected systematic review,Critical Appraisal of Individual Studies. The quality of the included diagnostic accuracy studies was assessed using the QUADAS. checklist 22 Numeric scores were not calculated Instead the strengths and limitations of the. study are summarized and presented narratively,SUMMARY OF EVIDENCE. Quantity of Research Available, The literature search yielded 408 citations After screening of abstracts from the literature. search and from other sources 24 potentially relevant studies were selected for full text review. Five studies were included in the review The PRISMA flowchart in Appendix 1 details the. process of the study selection,Summary of Study Characteristics.
A detailed summary of the included studies characteristics is provided in Appendix 2. Study design, Five diagnostic accuracy studies were included 23 27. Population,Pediatric Thermometers 3, One study included 40 children age 0 to 24 months mean 10 9 months with fever higher than. 38 C attending a children hospital 23 One study included 254 children 1 to 24 months old. median 7 months with fever higher than 38 C attending a private pediatric practice 24 One. study included 663 sick newborns fever status not reported attending NICU neonatal. intensive care unit 25 One study included 50 febrile fever higher than 38 C and 50 afebrile. children aged 2 to 12 years mean age 6 1 and 6 15 years respectively attending the pediatric. emergency room of a children s hospital 26 One study included 94 febrile fever higher than. 38 C and 111 afebrile children of all ages mean age 66 months attending a general hospital. outcomes were categorized into under or above 2 years old 27 In the included studies children. were included for assessment when fever was documented in the emergency departments or at. some point during hospitalization types of thermometers used not indicated. Interventions and comparators, One study compared a digital temporal artery thermometer Temporal Scanner with a digital. rectal thermometer Sure Temp 23 One study compared an infrared skin contact temporal. artery thermometer VoiceThermo wdc 6603 B and an infrared tympanic thermometer. ThermoScan 6022 with a traditional rectal digital thermometer as the standard comparator. brand not indicated 24 One study compared a digital axillary thermometer Microlife MT3001. rectal glass mercury thermometer brand not indicated infrared tympanic thermometer First. Temp Genius and infrared skin contact temporal artery thermometer Thermoflash LX 26. with a traditional axillary glass mercury thermometer as standard comparator brand not. indicated 25 One study compared a digital axillary thermometer Omron MC 106 infrared. tympanic thermometer Equinox ET 99 and digital temporal artery thermometer Temporal. Scanner with a traditional rectal glass mercury thermometer Hicks as standard comparator 26. One study compared an infrared tympanic thermometer ThermoScan PRO 4000 and infrared. temporal artery thermometer Temporal ScannerTM TAT 5000 with a digital rectal thermometer. Sure Temp as standard comparator 27, One study reported the correlation between measurements of the two types of tested. thermometers patient comfort and required nursing time 23 One study reported the difference in. measurements of the tested thermometers compared to the reference standard rectal digital. thermometer limits of agreement the range or scatter in which 95 of the measurement. values which are different between the intervention and the comparator lie relative to the zero. difference line i e the smaller the scatter the better the agreement sensitivity and. specificity 24 One study reported the correlation between the tested thermometers to the. comparator and clinical differences defined as a mean difference of 0 2 C to the comparator. measurements 25 One study reported the correlation between the tested thermometers to the. comparator limits of agreement difference in measurements compared to the comparator. sensitivity and specificity 26 One study reported the difference in measurements of the tested. thermometers compared to the comparator 27,Summary of Critical Appraisal.
The included diagnostic accuracy studies 23 27 have good validity limited time period between. reference and standard tests to minimize the possibility of a change in status between tests test. execution described in sufficient detail to permit their replication and generalizability selection. criteria clearly described patients representative of the population in practice of results except. Pediatric Thermometers 4, it is unclear whether the index test results were interpreted without knowledge of the results of. the reference standard and whether the reference standard results were interpreted without. knowledge of the results of the index test A limitation common to all included studies was the. use of rectal or axillary thermometry as standard comparator despite the fact that they do not. necessarily reflect core body temperature, Details of the strengths and limitations of the included studies are summarized in Appendix 3. Summary of Findings, Main findings of included studies are summarized in detail in Appendix 4. 1 What is the comparative clinical effectiveness of temporal artery thermometers with. tympanic rectal or axilla thermometers in febrile pediatric patients two years of age and. older and in patients younger than two years of age. There was no evidence found on the comparative clinical effectiveness of temporal artery. thermometers with tympanic rectal or axilla thermometers in febrile pediatric patients two years. of age and older and in patients younger than two years of age. 2 What is the comparative accuracy of temporal artery tympanic rectal or axilla. thermometers in febrile pediatric patients two years of age and older and in patients. younger than two years of age,For children up to 2 years old. Digital temporal artery thermometer compared with digital rectal thermometer. One study compared digital temporal artery thermometers with digital rectal thermometers as. the reference standard in 40 children 0 to 24 months old mean 10 9 months with fever higher. than 38 C attending a children hospital 23, Temporal artery and rectal measurements had a correlation of 0 776 Temporal artery.
measurements had a mean difference of 0 03 C compared to rectal measurements. difference not statistically significant and 94 7 of measurements differed by less than 1 0 C. Patients experienced greater discomfort with the rectal thermometry method compared to the. temporal artery method P 0 05 Temporal artery measurements required less nursing time. for measurement mean 47 seconds for rectal measurement and 6 seconds for temporal artery. measurement P 0 01, The authors concluded that temporal artery thermometry is as effective more comfortable and. offers significant savings in nursing time when compared to rectal thermometry. Infrared skin temporal artery thermometer and infrared tympanic thermometer compared with. traditional digital rectal thermometer,Pediatric Thermometers 5. One study compared infrared skin temporal artery thermometers and infrared tympanic. thermometers with traditional digital rectal thermometers as the reference standard in 254. children 1 to 24 months old median 7 months with fever higher than 38 C attending a private. pediatric practice 24, Tympanic measurement was 0 1 C lower than rectal measurement and temporal artery. measurement was 0 15 C lower than rectal measurement All differences were statistically. significant however these differences do not exceed the 0 2 C described in other studies 25 as. the threshold for clinical significance, Temporal thermometer was less sensitive and less specific than tympanic thermometer for. detecting rectal fever 38 C, The limits of agreement were 0 73 C to 1 04 C for the tympanic measurement and 0 18 C to.
1 64 C for the temporal artery measurement, The authors concluded that both the infrared tympanic and infrared skin temporal artery. thermometers recorded lower temperatures than the traditional rectal thermometers The limits. of agreement were particularly wide for the temporal artery thermometer and were. recommended not to be used in pediatric practice, Digital axillary thermometers glass mercury rectal thermometers infrared tympanic. thermometers and infrared contact temporal artery thermometers compared with traditional. glass mercury axillary thermometers, One study compared digital axillary thermometers rectal glass mercury thermometers infrared. tympanic thermometers infrared skin temporal artery thermometers with traditional axillary. glass mercury thermometers AGMT as the reference standard in 663 sick newborns attending. NICU 25 This study did not mention fever as an inclusion criterion for its population so this may. be a confounding factor for the findings, Correlations to AGMT measurements were 0 94 for both digital axillary thermometers and. tympanic thermometers 0 74 for temporal artery thermometers and 0 87 for rectal glass. mercury thermometers, The mean difference to AGMT measurements was 0 02 C for digital axillary thermometers.
0 03 C for tympanic thermometers 0 55 C for temporal artery thermometers and 0 25 C for. rectal glass mercury thermometers all differences are statistically significant When clinical. difference was defined as a mean difference of 0 2 C there was no difference between both. mean AGMT vs digital axillary thermometer measurements and AGMT vs infrared tympanic. thermometer measurements, The authors concluded that the infrared tympanic thermometer could be a practical method for. fever detection for sick newborns,For children 2 years old. different types of thermometers having been 4used for these two populations in clinical practice

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