Article #10
Temperature Measurements Comparison of different thermometer types for patients with cancer
Deborah Gates, RN, BSN, MSN, Victoria Horner, PhD, BSc, BSN, RN, OCN®, Lindsey Bradley, RN, OCN®, Takeya Fogle Sheperd, MSN, APRN, FNP-C, Omena John, RN, BSN, and Melinda Higgins, PhD
BACKGROUND: Accurate temperature measurement in patients with cancer is critical. Many patients are neutropenic; therefore, fever represents an oncologic emergency, and, in many cases, it can be the only indication of a life-threatening infection. Although oral thermometers most closely rep resent true core temperature, patients may have barriers to oral thermometry.
OBJECTIVES: The purpose of this study was to assess the accuracy of two alternative, noninvasive thermometers (tympanic and temporal artery) by comparing them to an oral thermometer.
METHODS: A method-comparison study design was used. Each participant received three temperature measurements. The dependent variable was the difference in temperature between the test thermometers and the oral thermometer.
RESULTS:
No statistically significant differences existed in demographic or diagnosis information between group 1 (tympanic, temporal artery, and oral) and group 2 (temporal artery, tympanic, and oral), meaning that the order of temperature measurement did not affect the results. In addition, no significant difference was noted in the temperatures obtained with the same thermometer between group 1 and group 2 (F[2,96] = 0.747; p = 0.476). Temperatures measured with the tympanic thermometer ranged from 35.3°C–40.2°C (mean = 37.6°C, SD = 1.13°C). Measurements were slightly higher for the temporal artery thermometer, ranging from 36.4°C–41.6°C (mean = 38.3°C, SD = 1.28°C). Oral thermometer measures were lowest, ranging from 36.3°C–39.5°C (mean = 37.5°C, SD = 0.82°C)
However, significant differences in temperatures were noted when comparing the three thermometers to one another (F[2,96] = 44.672; p < 0.001), with the temporal artery thermometer having significantly higher temperatures than the tympanic thermometer (p < 0.001) and oral thermometer (p < 0.001). When compared to the oral thermometer, the tympanic thermometer was not significantly different (p = 0.381), with temperature differences ranging from –1.2°C below the oral standard to 1.3°C above, with a mean difference (bias) of 0.126 and standard deviation of these differences (precision) of 0.616. However, the significant differences between the oral thermometer and the temporal artery thermometer (p < 0.001) had temperature differences ranging from –0.4°C below the oral standard to 2.5°C above, with a mean difference (bias) of 0.796 and a standard deviation of these differences (precision) of 0.718.
FINDINGS: The results suggest that neither of the test thermometers accurately represented core temperature, particularly in febrile patients. Both the tympanic and temporal artery thermometers became less accurate as oral temperature increased.
Implications for Practice
The results of this study suggest several implications for change in clinical practice. The accuracy of the temporal artery thermometer decreased with increasing oral temperature. The use of temporal artery thermometers may lead to false identification of fevers and, subsequently, unnecessary clinical interventions such as antimicrobial therapy, blood cultures, and x-rays.
CONCLUSION:
Accurate temperature measurements in patients with cancer is critical. The results of the current study suggest that oral thermometers should be used whenever possible within a wide range of settings and populations, and that care should be taken when interpreting temperatures from alternative thermometers in febrile patients. The results also highlight that thermometer technology has room for improvement (Niven et al., 2015), leaving few available alternatives to oral thermometry for oncology (and other special populations) (Bonzi et al., 2016). Modifications to the oral probe or innovations to decrease the possibility of user error with tympanic thermometers may greatly improve the accuracy of temperature measurement in the future.
Discussion Starting Points:
Please choose two for your response:
How does this research article compare to our practice, policy and or procedure?
What are the advantages and disadvantages to the proposed recommendations in the article?
What are the advantages and disadvantages of implementing the article recommendations on your unit and/or hospital?
Was the correct method used? Why or why not?
What are the advantages and disadvantages to the proposed recommendations in the article?
ReplyDeleteI work on an Oncology floor where we have a lot of patients who experience neutropenic fevers post chemo. This article confirmed the best practice for accurately measuring the temperature of these patients. Accurate measurements will be very significant with the much needed intervention such as blood cultures, antibiotics, etc..
Was the correct method used? Why or why not?
I strongly believe that the correct method was used since they primarily performed it with patients, into consideration their ANC accurately identifying the patients as neutropenic. The studly also used a comparison of different instruments and areas of measuring temperature (oral axillary and temporal).
Marzenna Messina
DeleteOur unit provides care to many neutropenic patient's. On the unit we have Vital Signs monitors with option to check temperature orally or axillary. We do not have any other temperature probes to measure temperature on our patients. Nurses are knowledgeable
that oral temperature measurement is most accurate and they use this way. However, at times they have to check axillary method instead due to mucositis, mouth or tongue swelling, etc.
It would be in advantage to implement this article recommendation. Accurate temperature data is critical for our patient population, especially neutropenic patients.
Nurses need to continue to use oral temperature measurement to our patients on our unit and nurses on the units that uses different types of temperature measurement need to be educated. The recommendations of this article should be implemented especially to other units.
What are the advantages and disadvantages to the proposed recommendations in the article?
DeleteThe study results recommend using oral thermometers to accurately obtain a true core temperature for oncology patients. If there are patients that have contraindications to using an oral thermometer; for example; mucositis, head and neck precautions, oral surgery or radiation, using a tympanic thermometer might be the next best thing. On 6NE we do not have tympanic thermometers on hand.
Was the correct method used? why or why not?
I think the correct method was used for this study; they used fifty participants on an oncology unit. They trained investigators on the proper use of oral, tympanic, and temporal artery thermometers. A limitation to this was that an investigator had to be present when patients were admitted into the unit and enrolled in the study. I think it would have been important to include taking axillary temperatures to check accuracy against the other methods. It is very important to accurately obtain a core temperature on our oncology population to prevent emergencies and longer lengths of stay in the hospital.
Obtaining an accurate temperature is critical on our oncology’s medical surgical unit. Very often our patient population is post chemo or surgery, neutropenic and/or septic. As noted in the article, obtaining an oral temperature reading is optimal, however in practice that is not always possible. Moreover, how accurate is the equipment?At times, crucial decisions regarding treatment are based on the temperature. Even though other aspects are regarded such as heart rate, labs, and physical presentation, temperature readings play a major role. It seems lacking to only have access to oral and axillary readings given the importance. The article didn’t include alternative ways such as via FC in the ICU.
DeleteThe study used proper method as researchers were trained and tested subjects using three methods. It discovered inaccuracies with non oral temperature readings and brought forth the need for alternative methods to obtain accurate measurements.
(This is my post above)
DeleteHow does this research article compare to our practice, policy and procedure?
ReplyDelete- This research article compares to our practice as we don’t really have a policy on correct temperature readings and what method we use. The Vitals monitoring system (Dynamaps) the hospital utilizes allows us to check body temps interchangeably from oral to axillary; it does not let us utilize temporal artery readings. To see that there is no significant reading difference from oral/temporal/tympanic shows that we don’t really have to change our practice. We as oncology nurses would just have to be more mindful when we do check temporal artery temperature readings as they can yield slightly higher results.
What are the advantages and disadvantages of the proposed recommendations in the article?
- An advantage of this article is giving oncology nurses peace of mind that we can use temporal artery/tympanic/oral temperature readings with minimal worry of false readings. Oftentimes we have patients who have severe oral mucositis and the thought of taking an oral temperature reading can be daunting for fear of having pain. We can offer/explain to patients in this situation that there are other ways to read temperature. This way gives the patients a sense of relief to be pain/discomfort free and alleviate any feelings of anxiety related pain caused by simple nursing acts such as vital signs monitoring.
ReplyDeleteWhat are the advantages and disadvantages of implementing the article recommendations on your unit and/or hospital
Fevers are important to monitor in oncology patients. The advantage of this proposal states that the best way to get an accurate temperature is using core temperature. The best method is oral, which is something our oncology floor does when getting vitals. However, the disadvantage is some of patient population are unable to get oral temperature due to mucositis and confused patients. The alternative method our floor uses is axillary.
Was the correct method used? Why or why not?
I believe this study has many limiting factors. The sample size is only 50 people and only focuses on three ways to get temperatures; oral, temporal, and tympanic. If they were to discover which temperature measurement was the best, it should have included axillary temperature. The only information with axillary temperature was in pediatrics making it difficult to conclude if it has the same results as adults.
How does this research article compare to our practice, policy and or procedure?
ReplyDeleteProvidence St. Joseph currently lacks a standardized policy specifying the required route for measuring patient temperatures. However, the vital sign monitors standard across units primarily accommodate oral and axillary methods. The literature supports oral route as the primary route whenever feasible. In an oncology setting, obtaining precise temperature measurements is critical—particularly for post-chemotherapy patients—to accurately detect and assess neutropenic fever.
What are the advantages and disadvantages to the proposed recommendations in the article?
The oral route is the gold standard for oncology patients because it balances high accuracy with patient safety. Sublingual readings closely reflect true core body temperature, ensuring early and reliable detection of neutropenic fever where missing a temperature spike could delay critical antibiotic treatment. Unlike axillary methods, which often underestimate body temperature, oral thermometry provides precise results without the high risk of mucosal injury linked to rectal probes. However, its main disadvantage is that readings can be inaccurate or contraindicated in patients with severe oral mucositis, active mouth sores, extreme tachypnea, or recent hot or cold fluid intake.
What are the advantages and disadvantages to the proposed recommendations in the article?
ReplyDeleteThe primary advantage of this recommendation is patient safety, particularly for individuals experiencing neutropenia. In oncology, fever is often the sole clinical indicator of a life-threatening infection, making diagnostic accuracy paramount. Adhering to oral thermometry ensures high sensitivity in detecting temperature elevations, thereby avoiding the risk of missed fevers caused by consistent underestimation seen with tympanic and temporal artery devices at higher temperatures. The main disadvantage of this recommendation lies in patient comfort and clinical feasibility. Many cancer patients face barriers to oral temperature measurement, such as mucositis, severe oral lesions, nausea, vomiting, or oxygen therapy, which can make oral thermometry difficult, painful, or impractical.
Was the correct method used? Why or why not?
Regarding the methodology, the researchers used an appropriate method-comparison study design. To determine if alternative noninvasive devices could replace established practice, the study directly compared paired measurements from tympanic and temporal artery thermometers against oral readings taken from the same participants. By defining the primary variable as the temperature difference between the test devices and the oral reference standard across a range of patient temperatures, the investigators could precisely measure bias and agreement. This statistical approach allowed them to reveal that device discrepancy worsens specifically as body temperature rises, confirming that their methodology was well-suited to test the accuracy and clinical safety of these temperature devices.
On the unit that I work at, we generally take patient’s temperature the oral method. Other alternative is axillary. It is very important that more accurate measurements are taken because we take care of neutropenic patients.
ReplyDeleteIf a patient’s temperature is elevated enough to be considered a fever, pancultures, antibiotics etc could be ordered, so it’s important that we have an accurate temperature reading to avoid unnecessary treatments are ordered
The method that was used is correct because it showed a side by side comparison of the alternative methods of taking temperatures. It showed the accuracy of each method which is very important in our oncology patient population. However, I wonder if a more thorough study have been done which will test the different methods against more influencing factors, such as age, sickness, condition of equipments, environmental conditions, would it yield a different outcome?
ReplyDelete