Authors: Niven DJ et al. Ann Intern Med 2015 Nov 17.
In a meta-analysis, the sensitivity of peripheral thermometers for detecting fever was only 64%.
Accurate evaluation of body temperature is essential in many clinical scenarios. In this systematic review and meta-analysis, researchers examined data from 75 prospective studies in which the accuracy of peripheral thermometers (tympanic membrane, temporal, axillary, or oral) was compared with central thermometers (pulmonary artery catheter [the gold standard for temperature measurement], urinary bladder, esophageal, or rectal). Analysis involved nearly 8700 patients; 42 studies were in adults, 32 studies were in children, and 1 study was in both.
The pooled sensitivity and specificity for detecting fever by peripheral thermometers were 64% and 96%, respectively; in other words, when a peripheral thermometer detected fever, it was likely present, but peripheral thermometers frequently missed fever. Sensitivity was lowest for axillary thermometers (42%).
These findings might have been skewed by publication bias (negative studies often are not published) as well as by differences in the temperature thresholds used to define fever in the populations studied. Nevertheless, the findings indicate that peripheral thermometers have poor sensitivity for detecting fever — an issue of particular concern in patients with low-grade fever. In such situations, central measurement of body temperature might be necessary.