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Table of Contents   
ORIGINAL ARTICLE
Year : 2021  |  Volume : 26  |  Issue : 5  |  Page : 324-326
 

Measurement of body temperature in postsurgical children: Comparisons of infrared nonskin contact digital thermometer, skin contact digital thermometer, and mercury in glass thermometer


Amardeep Multispeciality Children Hospital and Research Centre, Ahmedabad, Gujarat, India

Date of Submission27-May-2020
Date of Decision22-Nov-2020
Date of Acceptance04-Feb-2021
Date of Web Publication16-Sep-2021

Correspondence Address:
Dr. Amar Shah
Amardeep Multispeciality Children Hospital and Research Centre, 65, Pritamnagar Society, Near Government Ladies Hostel, Near Gujarat College, Ellisbridge, Ahmedabad - 380 006, Gujarat
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jiaps.JIAPS_188_20

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   Abstract 


Context: Postoperative fever is known to occur after all surgical procedures irrespective of the type of anesthesia. Thermometry devices that work without touching or disturbing the child seem to be appreciated more than the conventional skin contact thermometers. However, whether this technology is reliable to be adapted for routine pediatric surgical care is debatable.
Aims: The aim of this study was to study the accuracy of infrared nonskin contact digital thermometer (IRT) compared to the skin contact digital thermometer (DT) and mercury in glass thermometer (MT).
Settings and Design: A prospective cross-sectional study was done in postoperative patients at a pediatric surgical center over a period of 3 months.
Subjects and Methods: The forehead temperature was recorded with IRT. This was followed by recording the temperature in one armpit by DT and the other armpit by MT. Readings were promptly documented.
Statistical Analysis Used: A sample t-test was done which gave the P value and mean. Linear regression analysis was carried out to find correlation coefficients. Bland–Altman test was used to access the concordance between all readings.
Results: We found a strong correlation between temperature readings taken by DT (mean = −0.03, r = 0.07, slope = −0.04) and IRT (mean = 0.89, r = 0.091, slope = −0.14). However, on comparison of results with the MT, there are wider limits of agreement with the IRT (−0.31–2.09) in comparison to DT (−0.66–0.59).
Conclusion: Skin contact digital thermometer are more accurate and suitable for checking body temperature as compared to infrared nonskin contact digital thermometer in postoperative pediatric patients.


Keywords: Digital skin thermometer, infrared thermometer, mercury skin thermometer


How to cite this article:
Jasani M, Jasani A, Shah A, Shah A. Measurement of body temperature in postsurgical children: Comparisons of infrared nonskin contact digital thermometer, skin contact digital thermometer, and mercury in glass thermometer. J Indian Assoc Pediatr Surg 2021;26:324-6

How to cite this URL:
Jasani M, Jasani A, Shah A, Shah A. Measurement of body temperature in postsurgical children: Comparisons of infrared nonskin contact digital thermometer, skin contact digital thermometer, and mercury in glass thermometer. J Indian Assoc Pediatr Surg [serial online] 2021 [cited 2022 Aug 17];26:324-6. Available from: https://www.jiaps.com/text.asp?2021/26/5/324/326069





   Introduction Top


Fever in a surgical patient is a cause for concern. Postoperative fever is known to occur irrespective of the type of anesthesia. Accurate documentation of the body temperature is mandatory to help the clinician make a decision regarding investigating the child or making a modification in the line of management. Irrespective of the technique used, the temperature should accurately reflect the core body temperature and should not be affected by any external factor. Body temperature in pediatric patients is commonly recorded in the axilla. This is being done using either a skin contact digital thermometer (DT) or a mercury in glass thermometer (MT). Body temperature record by the MT has been considered as a gold standard to ascertain core body temperature. However, the time taken to achieve an accurate reading is around 5 min, which is quite difficult to achieve in pediatric patients.[1] Mercury is a known hazard to humankind, and hence, the World Health Organization has been suggesting health-care professionals to move from the mercury in glass thermometers to DTs for recording body temperature.[2] Studies have been done and recommendations rolled out, suggesting that axillary temperature measurement with DT is as acceptable as mercury in glass thermometer.[3],[4] The DT has also been shown to be easy to use for health-care workers. Over the past few years, infrared nonskin contact DTs (IRT) have emerged as a new option for recording body temperature. This study was carried out to determine the accuracy of infrared nonskin contact DTs (IRT) compared to the axillary skin contact digital thermometer and Mercury in glass thermometer (MT) in postoperative children.


   Subjects and Methods Top


A prospective study was carried out over a period of 3 months on all postsurgical patients at a pediatric surgical center from July 1, 2019, to August 31, 2019. A total of 152 readings were taken. Patients' temperature was recorded with IRT (Braun NTF 3000) followed by DT (Dr. Morepen MT-222) in one armpit and MT (Hicks Clinical Thermometer) in another armpit.

IRT was aimed at the forehead area between eyebrows after making sure that the skin was free of sweat or dirt. DT was kept in armpit till beep sound was made by thermometer. MT was kept in the opposite armpit for 5 min.[1] All readings were taken by trained nursing staff with vision of 6/6. The aid of a magnifying glass was taken when required to reduce bias. All readings were recorded in degree Fahrenheit and promptly documented. To study all the values obtained by IRT and DT, a similar and statistically significant sample t-test was done which gave the P value and mean.[5] Following this, linear regression analysis was carried out to find correlation coefficients to provide information about the strength and direction of the relationship between two continuous variables.[6] To assess the concordance between the MT with DT and IRT readings, the Bland–Altman test was used.[7] This is an exploratory diagnostic test between the differences of the two temperature readings of each patient. It is plotted on the Y-axis against the means of the two temperatures plotted on the X-axis. There are two parameters of interest. The first is the overall mean difference for the paired readings of each patient. A value of zero implies perfect concordance. The second and more important parameter is the 95% limits of agreement (LOAs) between the two paired readings across the range of temperatures. It is a range within which we would expect 95% of the differences to lie. The tighter the LOAs, the better the concordance. The wider the range, the lesser would be the concordance in the two readings.


   Results Top


After analyzing data of all 152 readings, we found that DT had a smaller mean difference value compared to IRT. Both, however, had a strong positive correlation ship when compared with MT. Analysis also showed that IRT had a higher slope and wider LOA in comparison to DT. The data are depicted in [Table 1] and [Figure 1] and [Figure 2].
Table 1: Statistical significance, correlation, and concordance of DT and IRT data against MT

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Figure 1: Bland - Altman chart - mercury in glass thermometer Vs skin contact digital thermometer

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Figure 2: Balnd - Altman chart - mercury in glass thermometer Vs infrared nonskin contact digital thermometer

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A comparison of mean, maximum, and minimum temperature for MT, DT, and IRT is depicted in [Table 2] and [Table 3].
Table 2: Summary measurements of temperatures

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Table 3: Summary measurements of temperatures

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   Discussion Top


Early postoperative fever is common in children. Most of these occurrences are benign and their incidence reduces between 24 and 72 h of the surgery.[8] Whatever the cause, it is prudent that an accurate documentation of the body temperature is made. Recording of the axillary skin temperature by the mercury in glass thermometers has been used for many years. Because of the hazards of mercury and the possibility of injury to the child following the breakage of the glass thermometers, DTs came into existence. Studies showed them to be as acceptable as their mercury counterparts in measuring the temperature. A child following surgery is always psychologically upset and cranky. Managing these children and their anxious parents is a daunting task for health-care workers. Something as simple as recording the body temperature may cause disturbance to the sleeping child and in turn can agitate both the patient and the parents. Placement of rectal or esophageal thermometer probes for continuous temperature monitoring can be very uncomfortable for children. Skin sensors on the other hand are not a reliable indicator of the core body temperature in the pediatric age group. Over the past few years, the infrared nonskin contact DTs (IRT) have emerged as a new option for recording body temperature. The nontouch method of measuring temperature may reduce the infection rate and discomfort in postoperative children. It has also been shown to be easy to use for health-care workers. There have been no studies comparing the results of MT, DT, and IRT in pediatric patients, and hence, this study was undertaken to evaluate the feasibility of IRT in postoperative children.

In our study, we saw a wide LOA between MT versus IRT (−0.31–2.09). Chiappini et al. in their study done on children more than 1 month reported a very narrow LOA (−0.62–0.76).[9] The sample size taken by Chiappini et al. was 250 patients where they had taken 3 readings with IRT of the same patient. In our study, the temperature readings were taken in every time the child had a fever until the time of discharge. This can be one of the reasons for this discrepancy. Hajela studied rectal mercury thermometer versus IRT on 260 neonates.[10] They found LOA to be −2.09–2.40, which is a bit higher than our study.[10] This can be attributed to the effect of warmer care in neonatal patients compared to no such care in pediatric patients in the present study. Berksoy et al. reported LOA of DT versus MT −1.5–2.6 which is equivalent to −0.66–0.59 LOA in our study.[11] Considering wider LOAs for IRT in comparison to DT, they are not optimal to replace or substitute DT.


   Conclusion Top


Through this study we will like to conclude that skin contact digital thermometers are more accurate and suitable for checking body temperature as compared to infrared nonskin contact digital thermometer in postoperative pediatric patients.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
Haddadin RB, Shamo'on HI. Study between axillary and rectal temperature measurements in children. East Mediterr Health J 2007;13:1060-6.  Back to cited text no. 1
    
2.
Bose-O'Reilly S, McCarty KM, Steckling N, Lettmeier B. Mercury exposure and children's health. Curr Probl Pediatr Adolesc Health Care 2010;40:186-215.  Back to cited text no. 2
    
3.
National Collaborating Centre for Women's and Children's Health (UK). Feverish Illness in Children: Assessment and Initial Management in Children Younger Than 5 Years. London: Royal College of Obstetricians & Gynaecologists (UK); 2013.  Back to cited text no. 3
    
4.
Crawford DC, Hicks B, Thompson MJ. Which thermometer? Factors influencing best choice for intermittent clinical temperature assessment. J Med Eng Technol 2006;30:199-211.  Back to cited text no. 4
    
5.
Skaik Y. The bread and butter of statistical analysis “t-test”: Uses and misuses. Pak J Med Sci 2015;31:1558-9.  Back to cited text no. 5
    
6.
Schneider A, Hommel G, Blettner M. Linear regression analysis: Part 14 of a series on evaluation of scientific publications. Dtsch Arztebl Int 2010;107:776-82.  Back to cited text no. 6
    
7.
Bland JM, Altman DG. Statistical methods for assessing agreement between two methods of clinical measurement. Lancet 1986;1:307-10.  Back to cited text no. 7
    
8.
Liang HH, Zhang MX, Wen YM, Xu XL, Mao Z, She YJ, et al. The incidence of and risk factors for postoperative fever after cleft repair surgery in children. J Pediatr Nurs 2019;45:e89-94.  Back to cited text no. 8
    
9.
Chiappini E, Sollai S, Longhi R, Morandini L, Laghi A, Osio CE, et al. Performance of non-contact infrared thermometer for detecting febrile children in hospital and ambulatory settings. J Clin Nurs 2011;20:1311-8.  Back to cited text no. 9
    
10.
Hajela R. Accuracy of Infrared Forehead Skin Thermometry in Newborns-A Comparison with Digital Axillary and Rectal Mercury Thermometers. JEMDS 2020;9:555-61.  Back to cited text no. 10
    
11.
Berksoy EA, Anıl M, Bıcılıoğlu Y, Gökalp G, Bal A. Comparison of infrared tympanic, non-contact infrared skin, and axillary thermometer to rectal temperature measurements in a pediatric emergency observation unit. Int J Clin Exp Med 2018;11:567-73.  Back to cited text no. 11
    


    Figures

  [Figure 1], [Figure 2]
 
 
    Tables

  [Table 1], [Table 2], [Table 3]



 

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    Abstract
   Introduction
   Subjects and Methods
   Results
   Discussion
   Conclusion
    References
    Article Figures
    Article Tables

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