The diagnostic accuracy of digital, infrared and mercury-in-glass thermometers in measuring body temperature: a systemat
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CE-SYSTEMATIC REVIEWS AND META-ANALYSIS
The diagnostic accuracy of digital, infrared and mercury‑in‑glass thermometers in measuring body temperature: a systematic review and network meta‑analysis Valentina Pecoraro1 · Davide Petri2 · Giorgio Costantino3 · Alessandro Squizzato4 · Lorenzo Moja5 · Gianni Virgili6 · Ersilia Lucenteforte2 Received: 15 August 2020 / Accepted: 28 October 2020 © The Author(s) 2020
Abstract Not much is known about how accurate and reproducible different thermometers are at diagnosing patients with suspected fever. The study aims at evaluating which peripheral thermometers are more accurate and reproducible. We searched Medline, Embase, Scopus, WOS, CENTRAL, and Cinahl to perform: (1) diagnostic accuracy meta-analysis (MA) using rectal mercury-in-glass or digital thermometry as reference, and bivariate models for pooling; (2) network MA to estimate differences in mean temperature between devices; (3) Bland–Altman method to estimate 95% coefficient of reproducibility. PROSPERO registration: CRD42020174996. We included 46 studies enrolling more than 12,000 patients. Using 38 °C (100.4 ℉) as cutoff temperature, temporal infrared thermometry had a sensitivity of 0.76 (95% confidence interval, 0.65, 0.84; low certainty) and specificity of 0.96 (0.92, 0.98; moderate certainty); tympanic infrared thermometry had a sensitivity of 0.77 (0.60, 0.88; low certainty) and specificity of 0.98 (0.95, 0.99; moderate certainty). For all the other index devices, it was not possible to pool the estimates. Compared to the rectal mercury-in-glass thermometer, mean temperature differences were not statistically different from zero for temporal or tympanic infrared thermometry; the median coefficient of reproducibility ranged between 0.53 °C [0.95 ℉] for infrared temporal and 1.2 °C [2.16 ℉] for axillary digital thermometry. Several peripheral thermometers proved specific, but not sensitive for diagnosing fever with rectal thermometry as a reference standard, meaning that finding a temperature below 38 °C does not rule out fever. Fixed differences between temperatures together with random error means facing differences between measurements in the order of 2 °C [4.5 ℉]. This study informs practitioners of the limitations associated with different thermometers; peripheral ones are specific but not sensitive. Keywords Body temperature · Diagnostic tests · Fever · Systematic review · Thermometers
Introduction Electronic supplementary material The online version of this article (https://doi.org/10.1007/s11739-020-02556-0) contains supplementary material, which is available to authorized users. * Ersilia Lucenteforte [email protected] 1
Department of Laboratory Medicine and Pathology, Ospedale Civile Sant’Agostino Estense, AUSL Modena, Modena, Italy
2
Department of Clinical and Experimental Medicine, University of Pisa, Via Roma, 10, 56126 Pisa, Italy
3
IRCCS Fondazione Ca’ Granda, Ospedale Maggiore Policlinico, UOC Pronto Soccorso e Medicina D’Urgenza, Università Degli Studi di Milano, Mila
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