A COMPARISON OF 3 A COMPARISON OF 3 METHODS OF
METHODS OF THERMOMETRY IN THERMOMETRY IN CRITICALLY ILL
CRITICALLY ILL CHILDRENCHILDREN
H Ibrahim, AN Lee, LL
Ong, YH Chan
KK Women’s and
Children’s Hospital,
Singapore
Current
Clinical
Practice
Tympanic thermometer (TT)
Rectal thermometer (RT)
Age group: More than 6 months Location: Hospital-wideInvasive: No
Age group: All agesLocation: Pediatric Intensive
Care Unit (PICU) onlyInvasive: Yes
Time taken: approx 3secs
Time taken: Continuous monitoring
Proposed
Clinical
No-contact temporalthermometer (NTT)
Time taken: 0.5secs
Age group: All agesLocation: Hospital-wideInvasive: No
Core temperature measurement ( ‘Gold standard’ - Invasive)Pulmonary artery • Highly invasive
Bladder• Risk of urethral trauma and urinary tract infections
Esophageal / Nasopharyngeal• Highly invasive
Rectal (RT)• Discomfort, causes emotional distress and risk of rectal injuries
Peripheral temperature measurement (Non -invasive)No-contact temporal thermometry (NTT)• Measures temporal artery temperature
Axillary thermometry
febrile children36 children, age 0-77 monthsSites: tympanic membrane (ITT), forehead, axillary, rectal and bladder ITT measurements more closely agreed with core temperature (bladder & rectal)ITT and rectal measurements less variability compared with axillary and forehead measurements
Nimah MM et al, Pediatr Crit Care Med 2006;7(1):48
Comparison of the temporal artery and rectal thermo metry in chil dren in the emergency department327 children, age less than 24 monthsSites: rectal and temporal artery (temporal scanner and sensor touch – both of which are contact modes)Correlation between rectal and temporal artery thermometry is not significantTemporal thermometry cannot substitute rectal thermometry
Schuh S et al, Pediatric Emergency Care 2004; 20(11): 736
Estimating core temperature in infants and children after cardia c surgery: a comparison of six methods19 postoperative cardiac patients, age group not specifiedSites: pulmonary artery (PA), bladder, nasopharyngeal, rectal, tympanic and axillarySignificant differences seen between PA temperature and those from rectal, tympanic and axillary No significant difference in temperatures between PA compared with bladder PA compared with
nasopharyngealMean differences from PA temperature in decreasing order: bladder, nasopharyngeal, rectal, axillary and
tympanic methodsMaxton FJC et al, Journal of Advanced Nursing 2004; 45(2): 214
There is no difference between (NTT-RT) and (TT-RT)
NULL HYPOTHESISNULL HYPOTHESIS
NTT – No-contact temporal thermometer
RT – Rectal thermometer
TT – Tympanic thermometer
Research design: Comparative descriptive study
Settings: KK Women’s and Children’s Hospital, Singapore
Target population: PICU patients, age more than 6 months to 16 years old
Sampling method: Convenience sample
Sampling size: 50 participants
METHODOLOGYMETHODOLOGY
Patients admitted to PICU
4 trained PICU nurses
1) Screen
Age from more than 6 months to 16 years old
Impaired forehead and anal skin integrityExternal head and cold source (e.g. warmer, bandage, cold compress)
3) Consented
Temperature readings were performed independently
and according to manufacturers’
recommendations
5) Data analysis
SPSSVERSION14
50 participants were recruited. One was excluded from analysis due to incomplete dataTemperature was taken using each of the 3 methods (TT, NTT and RT) at 8 distinctive time points respectivelyAll 95% confidence intervals and p-values were calculated after adjusting for the cluster effects by the use of robust standard errorsAge of participants: 6.7 months to 16 years old with a mean age of 5.8 years (40.8% male and 59.2% female)Mean difference of (TT-RT): -0.1oC (p value=0.01); 95% confidence interval (-0.24, -0.03) Mean difference of (NTT-RT): 0.2oC (p value=0.049); 95% confidence interval (0.001, 0.35) The difference in mean between TT and NTT was -0.3oC (p value<0.001); 95% confidence interval
0.45, -0.17) TT has a stronger correlation with RT compared to NTT (R2 = 0.5 vs. 0.3)
NTT overestimate the core temperature by a mean of 0.2oCTT underestimate the core temperature by mean of 0.1oC There is statistically significant difference observed between the means of (NTT-RT) and (TT-RT), with p value of <0.001 15.6% of NTT readings were found to have under or over-read RT readings by greater than 1oC as compared to 4.3% of TT readingsTherefore, with such a difference, it is clinically not acceptable to use NTT
Limitations:Repeated measurements were done on the same patient This is a pilot study to determine the feasibility of use of NTT in the clinical setting, the sample size may be underpowered.
Clinical implication:In a unit where temperature readings are important determinants in a child’s diagnosis and
treatment plan, NTT cannot be recommended as an alternative mode of temperature measurement from this study.
Kimberger O, Cohen D, Illievich U and Lenhardt R (2007) Temporal artery versus bladder thermometry during perioperative and intensive care unit monitoring. International Anesthesia Research Society, 105 (4), 1042 – 1047.
Maxton FJC, Justin L and Gillies D (2004) Estimating core temperature in infants and children after cardiac surgery: a comparison of six methods. Journal of Advanced Nursing, 45 (2), 214 – 222.
Nimah MM, Bshesh K, Callahan JD & Jacobs BR (2006) Infrared tympanic thermometry in comparison with other temperature measurement techniques in febrile children. Pediatr Crit Care Med, 7 (1), 48 – 55.
Schuh S, Komar L, Stephens D, Read S & Allen U (2004) Comparison of the temporal artery and rectal thermometry in children in the emergency department. Pediatric Emergency Care, 20 (11), 736 – 741.