Accuracy of Peripheral Thermometers for Estimating Temperature: A Systematic Review and Meta-analysis.

Background: Body temperature is commonly used to screen patients for infectious diseases, establish diagnoses, monitor therapy, and guide management decisions. Purpose: To determine the accuracy of peripheral thermometers for estimating core body temperature in adults and children. Data Sources: MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, and CINAHL Plus from inception to July 2015. Study Selection: Prospective studies comparing the accuracy of peripheral (tympanic membrane, temporal artery, axillary, or oral) thermometers with central (pulmonary artery catheter, urinary bladder, esophageal, or rectal) thermometers. Data Extraction: 2 reviewers extracted data on study characteristics, methods, and outcomes and assessed the quality of individual studies. Data Synthesis: 75 studies (8682 patients) were included. Most studies were at high or unclear risk of patient selection bias (74%) or index test bias (67%). Compared with central thermometers, peripheral thermometers had pooled 95% limits of agree-ment (random-effects meta-analysis) outside the predefined clinically acceptable range (+/- 0.5 degrees C), especially among patients with fever (-1.44 degrees C to 1.46 degrees C for adults; -1.49 degrees C to 0.43 degrees C for children) and hypothermia (-2.07 degrees C to 1.90 degrees C for adults; no data for children). For detection of fever (bivariate random-effects meta-analysis), sensitivity was low (64% [95% CI, 55% to 72%]; I-2 = 95.7%; P < 0.001) but specificity was high (96% [CI, 93% to 97%]; I-2 = 96.3%; P < 0.001). Only 1 study reported sensitivity and specificity for the detection of hypothermia. Limitations: High-quality data for some temperature measurement techniques are limited. Pooled data are associated with interstudy heterogeneity that is not fully explained by stratified and metaregression analyses. Conclusion: Peripheral thermometers do not have clinically acceptable accuracy and should not be used when accurate measurement of body temperature will influence clinical decisions. Primary Funding Source: None.