Accuracy and reliability of temperature measurement in the emergency department by instrument and site in children.

PURPOSE

1. To determine the accuracy, precision, specificity, sensitivity, positive prediction, and negative prediction of TempaDOT, FirstTEMP, and Genius as compared to the glass mercury thermometer; 2. To determine the influence of age, behavior, febrile status, tympanic membrane bulge, presence of ear wax, and site on temperature readings; and 3. To determine the ability of each instrument to detect a shift in temperature after Tylenol.

METHOD

A quasi-experimental, multiple-correlational design was used to study 960 temperature measurements obtained on 89 febrile and 83 afebrile children in an emergency unit.

FINDINGS

TempaDOT was found to be the most accurate and most precise instrument for children ages 5 years and under with and without fevers. FirstTEMP was found to be most sensitive for temperatures above 37.5 degrees C and best in detecting shifts after Tylenol was given. Age, behavior, febrile status or tympanic membrane bulge did not significantly affect accuracy. The most accurate sites in order of accuracy were: oral axillary, aural, rectal. The order of precision of sites was: oral, aural, rectal, and axillary. Behavior did not significantly affect the precision.

CONCLUSION

TempaDOT was found to be the most clinically useful temperature measurement instrument. FirstTEMP may be used as a screening tool to determine if antipyretic medication is working to decrease fevers. TempaDOT is recommended for use in emergency units to validate the presence or absence of fevers in children especially when the FirstTEMP reading is near 37.0-38.8 degrees C.