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Thermometers and the detection of fever<br />

reported to be comparable with other thermometers used in the axilla. In the one study to compare<br />

the ability to detect fever against rectal temperature, the sensitivity was 68%. (EL II)<br />

Tympanic temperature (by infrared thermometer)<br />

Tympanic measurement differs on average from body temperature by 0.3°C. From EL Ib and EL II<br />

studies the difference between tympanic temperature and body temperature can be up to 0.74°C<br />

below to 1.34°C above and this varies with age, mode, environment temperature and device. The<br />

sensitivity to detect fever ranged from 51% to 97% in these studies.<br />

Some studies reported that tympanic measurements are difficult or inaccurate in infants under the age<br />

of 3 months. Other studies reported that the technique could be used in infants of all ages, including<br />

neonates. A statement that tympanic measurements should not be used in infants under the age of<br />

3 months was put to the Delphi panel. Consensus was not attained.<br />

Forehead temperature (by chemical thermometer)<br />

Data on the measurement of forehead temperature is sparse. The limited data suggests that forehead<br />

measurement appears to be inaccurate (underestimates body temperature by 1.2°C on average).<br />

(EL II) Forehead thermometers may be poor at detecting fever (sensitivity 27–88%). (EL II)<br />

Temporal artery temperature (by infrared thermometer)<br />

Measurement of temporal artery temperature has not been extensively studied. The available data<br />

suggest this technique has fair sensitivity (81%) to detect fever. (EL III)<br />

Health economics profile<br />

Cost analysis of thermometers was undertaken for this guideline (chapter 11). The analysis was<br />

based on the data from hospital setting as regards the annual number of measurements. 85 The results<br />

of the analysis are summarised in Table 5.3. The results are discounted to show the present value of<br />

costs which accrue in the future (up to 10 years). The analysis showed that the contact/electronic<br />

thermometers are the least costly option when staff costs are not included in the analysis. When the<br />

staff cost are included, the total cost of electronic/compact, contact/compact electronic and tympanic<br />

thermometers are comparable. Contact/electronic thermometers have a high purchase price but the<br />

fact that they can be used repeatedly means that they may be less costly per test than the chemical<br />

thermometers, which have a low purchase price but can be used only once (or can be reused only a<br />

limited number of times). Since the cost per test is dependent on the volume of tests undertaken,<br />

chemical thermometers may be a better use of resources than either electronic thermometer in very<br />

low volume settings, such as some primary care providers.<br />

GDG translation<br />

The GDG noted that the alternatives to oral and rectal thermometers can all give inaccurate readings<br />

and have variable sensitivity in detecting fever. Taking temperatures by the axillary route using an<br />

electronic or chemical dot thermometer underestimates body temperature by 0.5°C on average.<br />

Tympanic temperatures measured with an infrared thermometer differ from body temperature by<br />

0.3°C on average. The GDG noted that these three types of measurements had not been compared<br />

with each other and therefore decided that they could not recommend one type over another. Data<br />

from neonates suggests that axillary measurements are more accurate in this age group and it was<br />

therefore decided to recommend this route at that age.<br />

The GDG was aware that some authorities suggest that tympanic measurements are unreliable or<br />

impossible to perform in infants under the age of 3 months. The evidence was inconclusive on this<br />

issue and when the question was put to the Delphi panel there was no consensus. Accordingly, the<br />

GDG felt that they could not suggest age limits on the use of tympanic thermometers. The GDG<br />

considered that more research was needed in this area. Moreover, it would be helpful if direct<br />

comparisons were made between all of the different thermometers that were recommended for use in<br />

young children.<br />

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