Evaluating the Interchangeability of Forehead, Tympanic, and Axillary Thermometers in Italian Paediatric Clinical Settings: Results of a Multicentre Observational Study

Purpose: This study was conducted to investigate the interchangeability of infrared forehead, digital axillary, and infrared tympanic thermometers while identifying the most reliable non-invasive body temperature measurement method in paediatric settings. Design and methods: A multicentre observational study was conducted enrolling all children less than or equal to 14 years of age requiring a temperature measurement and after obtaining their parent's informed consent. Sociodemographic characteristics and temperature values in Celsius (degrees C) were simultaneously collected using forehead, axillary, and tympanic thermometers. Results: A total of 433 children were enrolled, 57.5% were male and the mean age was 5.3 = 3.9 years. The average value of tympanic temperature (37.05 degrees C) was higher than forehead (36.87 degrees C) and axillary (36.8 degrees C). The mean difference between axillary and forehead temperatures (-0.06 degrees C) was not statistically significant (p = 0.158). Comparing the measurements of each type of thermometer with the overall average of the three measurements recorded as the virtual gold standard, Bland Altman analysis highlighted tympanic with narrower 95% limits of agreement (+0.96 degrees C to -0.68 degrees C). The tympanic thermometer also had the highest percentage (81.6%) of differences falling within the maximum clinically acceptable difference (+/- 0.5 degrees C). Conclusions: Differences between paired measurements of the three investigated devices demonstrated the devices are not interchangeable. Measurements using the tympanic thermometer more closely resembled the reference temperature indicating its preferential use in paediatric clinical practice. Practice implications: To safely and consistently measure body temperature, nurses should not assume peripheral thermometers are interchangeable. It is essential to clinically validate all temperature values with clinical observations. (C) 2019 Published by Elsevier Inc.