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.