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

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 aged ≤5 years visiting their GP with an acute illness.Design and settingMethod comparison study with nested qualitative component.MethodTemperature measurements were taken with electronic axillary (Welch Allyn SureTemp®), electronic tympanic (Braun Thermoscan®), NCIT Thermofocus® 0800, and NCIT Firhealth 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°C (95% confidence interval [CI] = −0.21 to −0.06°C); lower limit of agreement was −1.57°C (95% CI = −1.69 to −1.44°C) and upper limit 1.29°C (95% CI = 1.16 to 1.42°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 whichever device was medically recommended.ConclusionIn a primary care paediatric population, temperature measurements with NCITs varied by >1°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 peripheral thermometer readings with caution and in the context of a holistic assessment of the child.

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Parents’ concerns and beliefs about temperature measurement in children: a qualitative study

BMC Family Practice ◽

10.1186/s12875-020-01355-y ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

Elizabeth Morris ◽

Margaret Glogowska ◽

Fatene Abakar Ismail ◽

George Edwards ◽

Susannah Fleming ◽

...

Keyword(s):

Temperature Measurement ◽

Technological Development ◽

Qualitative Interviews ◽

Method Comparison ◽

Febrile Illness ◽

Diagnostic Value ◽

Response To Treatment ◽

Method Comparison Study ◽

Monitoring Response ◽

Parents Experiences

Abstract Background Nearly 40% of parents with children aged 6 to 17 months consult a healthcare professional when their child has a high temperature. Clinical guidelines recommend temperature measurement in these children, but little is known about parents’ experiences of and beliefs about temperature measurement. This study aimed to explore parents’ concerns and beliefs about temperature measurement in children. Methods Semi-structured qualitative interviews were conducted from May 2017 to June 2018 with 21 parents of children aged 4 months to 5.5 years, who were purposively sampled from the METRIC study (a method comparison study comparing non-contact infrared thermometers to axillary and tympanic thermometers in acutely ill children). Data analysis followed a thematic approach. Results Parents described the importance of being able to detect fever, in particular high fevers, and how this then influenced their actions. The concept of “accuracy” was valued by parents but the aspects of performance which were felt to reflect accuracy varied. Parents used numerical values of temperature in four main ways: determining precision of the thermometer on repeat measures, detecting a “bad” fever, as an indication to administer antipyretics, or monitoring response to treatment. Family and social networks, the internet, and medical professionals and resources, were all key sources of advice for parents regarding fever, and guiding thermometer choice. Conclusions Temperature measurement in children has diagnostic value but can either empower, or cause anxiety and practical challenges for parents. This represents an opportunity for both improved communication between parents and healthcare professionals, and technological development, to support parents to manage febrile illness with greater confidence in the home.

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Non-contact infrared thermometers compared with current approaches in primary care for children aged 5 years and under: a method comparison study

Health Technology Assessment ◽

10.3310/hta24530 ◽

2020 ◽

Vol 24 (53) ◽

pp. 1-28 ◽

Cited By ~ 1

Author(s):

Ann Van den Bruel ◽

Jan Verbakel ◽

Kay Wang ◽

Susannah Fleming ◽

Gea Holtman ◽

...

Keyword(s):

Primary Care ◽

Confidence Interval ◽

Lower Limit ◽

Method Comparison ◽

Health Technology ◽

Comparison Study ◽

Infrared Thermometer ◽

Upper Limit ◽

The Difference ◽

Method Comparison Study

Background Current options for temperature measurement in children presenting to primary care include either electronic axillary or infrared tympanic thermometers. Non-contact infrared thermometers could reduce both the distress of the child and the risk of cross-infection. Objectives The objective of this study was to compare the use of non-contact thermometers with the use of electronic axillary and infrared tympanic thermometers in children presenting to primary care. Design Method comparison study with a nested qualitative study. Setting Primary care in Oxfordshire. Participants Children aged ≤ 5 years attending with an acute illness. Interventions Two types of non-contact infrared thermometers [i.e. Thermofocus (Tecnimed, Varese, Italy) and Firhealth (Firhealth, Shenzhen, China)] were compared with an electronic axillary thermometer and an infrared tympanic thermometer. Main outcome measures The primary outcome was agreement between the Thermofocus non-contact infrared thermometer and the axillary thermometer. Secondary outcomes included agreement between all other sets of thermometers, diagnostic accuracy for detecting fever, parental and child ratings of acceptability and discomfort, and themes arising from our qualitative interviews with parents. Results A total of 401 children (203 boys) were recruited, with a median age of 1.6 years (interquartile range 0.79–3.38 years). The readings of the Thermofocus non-contact infrared thermometer differed from those of the axillary thermometer by –0.14 °C (95% confidence interval –0.21 to –0.06 °C) on average with the lower limit of agreement being –1.57 °C (95% confidence interval –1.69 to –1.44 °C) and the upper limit being 1.29 °C (95% confidence interval 1.16 to 1.42 °C). The readings of the Firhealth non-contact infrared thermometer differed from those of the axillary thermometer by –0.16 °C (95% confidence interval –0.23 to –0.09 °C) on average, with the lower limit of agreement being –1.54 °C (95% confidence interval –1.66 to –1.41 °C) and the upper limit being 1.22 °C (95% confidence interval 1.10 to 1.34 °C). The difference between the first and second readings of the Thermofocus was –0.04 °C (95% confidence interval –0.07 to –0.01 °C); the lower limit was –0.56 °C (95% confidence interval –0.60 to –0.51 °C) and the upper limit was 0.47 °C (95% confidence interval 0.43 to 0.52 °C). The difference between the first and second readings of the Firhealth thermometer was 0.01 °C (95% confidence interval –0.02 to 0.04 °C); the lower limit was –0.60 °C (95% confidence interval –0.65 to –0.54 °C) and the upper limit was 0.61 °C (95% confidence interval 0.56 to 0.67 °C). Sensitivity and specificity for the Thermofocus non-contact infrared thermometer were 66.7% (95% confidence interval 38.4% to 88.2%) and 98.0% (95% confidence interval 96.0% to 99.2%), respectively. For the Firhealth non-contact infrared thermometer, sensitivity was 12.5% (95% confidence interval 1.6% to 38.3%) and specificity was 99.4% (95% confidence interval 98.0% to 99.9%). The majority of parents found all methods to be acceptable, although discomfort ratings were highest for the axillary thermometer. The non-contact thermometers required fewer readings than the comparator thermometers. Limitations A method comparison study does not compare new methods against a reference standard, which in this case would be central thermometry requiring the placement of a central line, which is not feasible or acceptable in primary care. Electronic axillary and infrared tympanic thermometers have been found to have moderate agreement themselves with central temperature measurements. Conclusions The 95% limits of agreement are > 1 °C for both non-contact infrared thermometers compared with electronic axillary and infrared tympanic thermometers, which could affect clinical decision-making. Sensitivity for fever was low to moderate for both non-contact thermometers. Future work Better methods for peripheral temperature measurement that agree well with central thermometry are needed. Trial registration Current Controlled Trials ISRCTN15413321. Funding This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 24, No. 53. See the NIHR Journals Library website for further project information.

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Preview Rapid Strep A Test Method Comparison Study

Case Medical Research ◽

10.31525/ct1-nct03907449 ◽

2019 ◽

Author(s):

Keyword(s):

Method Comparison ◽

Test Method ◽

Comparison Study ◽

Method Comparison Study

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Evaluation of point‐of‐care testing device for anemia detection: A cross‐sectional method comparison study from Thailand

Journal of Clinical Laboratory Analysis ◽

10.1002/jcla.23976 ◽

2021 ◽

Author(s):

Wittawat Chantkran ◽

Pitipat Jamnarnwej ◽

Pipat Sritanabutr ◽

Pasra Arnutti

Keyword(s):

Point Of Care ◽

Method Comparison ◽

Testing Device ◽

Comparison Study ◽

Point Of Care Testing ◽

Cross Sectional ◽

Method Comparison Study

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Independent prescribing by advanced Physiotherapists for patients with low back pain in primary care: feasibility trial with an embedded qualitative-component

Physiotherapy ◽

10.1016/j.physio.2020.03.070 ◽

2020 ◽

Vol 107 ◽

pp. e51

Author(s):

T. Noblet ◽

A. Rushton ◽

J. Marriott

Keyword(s):

Primary Care ◽

Low Back Pain ◽

Back Pain ◽

Feasibility Trial ◽

Low Back ◽

Independent Prescribing ◽

Qualitative Component

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Optimization of PV array inclination in India using ANN estimator: Method comparison study

Sadhana ◽

10.1007/s12046-015-0386-2 ◽

2015 ◽

Vol 40 (5) ◽

pp. 1457-1472 ◽

Cited By ~ 6

Author(s):

T V DIXIT ◽

ANAMIKA YADAV ◽

S GUPTA

Keyword(s):

Method Comparison ◽

Comparison Study ◽

Pv Array ◽

Method Comparison Study

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Improving the Care of People with Long-Term Conditions in Primary Care: Protocol for the Enhance Pilot Trial

Journal of Comorbidity ◽

10.15256/joc.2015.5.60 ◽

2015 ◽

Vol 5 (1) ◽

pp. 135-149 ◽

Cited By ~ 3

Author(s):

Emma L. Healey ◽

Clare Jinks ◽

Valerie A. Tan ◽

Carolyn A. Chew-Graham ◽

Sarah A. Lawton ◽

...

Keyword(s):

Primary Care ◽

Controlled Trial ◽

Qualitative Interviews ◽

Pilot Trial ◽

Integrated Approach ◽

Long Term Conditions ◽

Delivery Of Care ◽

Care Protocol ◽

Engagement Assessment

Background Long-term conditions (LTCs) are important determinants of quality of life and healthcare expenditure worldwide. Whilst multimorbidity is increasingly the norm in primary care, clinical guidelines and the delivery of care remain focused on single diseases, resulting in poorer clinical outcomes. Osteoarthritis, and anxiety and/or depression frequently co-occur with other LTCs, yet are seldom prioritized by the patient or clinician, resulting in higher levels of disability, poorer prognosis, and increased healthcare costs. Objective To examine the feasibility and acceptability of an integrated approach to LTC management, tackling the under-diagnosis and under-management of osteoarthritis-related pain and anxiety and/or depression in older adults with other LTCs in primary care. Design The ENHANCE study is a pilot stepped-wedge cluster randomized controlled trial to test the feasibility and acceptability of a nurse-led ENAHNCE LTC review consultation for identifying, assessing, and managing joint pain, and anxiety and/or depression in patients attending LTC reviews. Specific objectives (process evaluation and research outcomes) will be achieved through a theoretically informed mixed-methods approach using participant self-reported questionnaires, a medical record review, an ENHANCE EMIS template, qualitative interviews, and audio recordings of the ENHANCE LTC review. Discussion Success of the pilot trial will be measured against the level of the primary care team engagement, assessment of training delivery, and degree of patient recruitment and retention. Patient satisfaction and treatment fidelity will also be explored. ISRCTN registry number: 12154418.

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Acceptability of a vocational advice service for patients consulting in primary care with musculoskeletal pain: A qualitative exploration of the experiences of general practitioners, vocational advisers and patients

Scandinavian Journal of Public Health ◽

10.1177/1403494817723194 ◽

2017 ◽

Vol 47 (1) ◽

pp. 78-85 ◽

Cited By ~ 2

Author(s):

Tom Sanders ◽

Gwenllian Wynne-Jones ◽

Bie Nio Ong ◽

Majid Artus ◽

Nadine Foster

Keyword(s):

Primary Care ◽

Controlled Trial ◽

Comparative Method ◽

Qualitative Interviews ◽

Cluster Randomised Controlled Trial ◽

Key Factors ◽

Constant Comparative Method ◽

General Practices ◽

Randomised Controlled ◽

Qualitative Exploration

Aims: Using qualitative interviews, this study explored the experiences of GPs, vocational advisers and patients towards a new vocational advice (VA) service in primary care. Methods: This study was nested within the Study of Work and Pain (SWAP) cluster randomised controlled trial. The SWAP trial located a VA service within three general practices in Staffordshire. Interviews took place with 10 GPs 12 months after the introduction of the VA service, four vocational advisers whilst the VA service was running and 20 patients on discharge from the VA service. The data were analysed using the constant comparative method, which is a variation of grounded theory. Results: The key factors determining the acceptability and perceived effectiveness of the VA service from the perspective of the three groups of stakeholders were (1) the timing of referrals to the VA, (2) the perceived lack of patient demand for the service and (3) role uncertainty experienced by VAs. Conclusions: Early vocational intervention may not be appropriate for all musculoskeletal patients with work difficulties. Indeed, many patients felt they did not require the support of a VA, either because they had self-limiting work difficulties and/or already had support mechanisms in place to return to work. Future VA interventions may be better implemented in a targeted way so that appropriate patients are identified with characteristics which can best be addressed by the VA service.

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