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).