Background: We aimed to compare the accuracy of individuals’ wrist and forehead temperatures with their tympanic temperature under different circumstances.
Methods: We performed a prospective observational study in a real-life population in Ningbo First Hospital in China. We consecutively recorded individuals’ wrist and forehead temperatures in Celsius (°C) using a noncontact infrared thermometer (NCIT). We also measured individuals’ tympanic temperature using a tympanic thermometer (IRTT) and defined fever as a tympanic temperature of ≥37.3 °C.
Results: We enrolled 528 participants, including 261 indoor and 267 outdoor participants. We grouped the outdoor participants into four groups according to their means of transportation to the hospital: by foot, by bicycle/electric vehicle, by car, or as a passenger in a car. Under different circumstances, the mean difference in the forehead measurement ranged from -1.72 to -0.56 °C across groups, and that in the wrist measurement ranged from -0.96 to -0.61°C. Both measurements had high fever screening abilities in indoor patients. (Wrist: AUC 0.790; 95% CI: 0.725-0.854, P<0.001; forehead: AUC 0.816; 95% CI: 0.757-0.876, P <0.001). The cut-off value of the wrist measurement for detecting a tympanic temperature of ≥37.3 °C was 36.2 °C, with 86.4% sensitivity and 67.0% specificity, and the best threshold for the forehead measurement was 36.2 °C, with 93.2% sensitivity and 60.0% specificity.
Conclusion: Wrist measurements are more stable than forehead measurements under different circumstances. Both measurements have favorable fever screening abilities in indoor patients. The cut-off values were both 36.2 °C.
1. Zumla A, Hui DS, Azhar EI, Memish ZA, Maeurer M (2020). Reducing mortality from 2019-nCoV: host-directed therapies should be an option. The Lancet, PE35-E36.
2. Wu JT, Leung K, Leung GM (2020). Nowcasting and forecasting the potential domestic and international spread of the 2019-nCoV outbreak originating in Wuhan, China: a modelling study. The Lancet, P689-697.
3. Wang W, Tang J, Wei F (2020). Updated understanding of the outbreak of 2019 novel coronavirus (2019‐nCoV) in Wuhan, China. J Med Virol, 441-447.
4. Wang D, Hu B, Hu C et al (2020). Clinical characteristics of 138 hospitalized patients with 2019 novel coronavirus–infected pneumonia in Wuhan, China. JAMA, 323(11):1061-1069.
5. Guan W-j, Ni Z-y, Hu Y et al (2020). Clinical characteristics of 2019 novel coronavirus infection in China. N Eng J Med. DOI 10.1056/NEJMoa2002032
6. Devrim I, Kara A, Ceyhan M et al (2007). Measurement accuracy of fever by tympanic and axillary thermometry. Pediatr Emerg Care, 23:16-19.
7. Mogensen CB, Wittenhoff L, Fruerhøj G, Hansen S (2018). Forehead or ear temperature measurement cannot replace rectal measurements, except for screening purposes. BMC Pediat, 18:15.
8. Erenberk U, Torun E, Ozkaya E et al (2013). Skin temperature measurement using an infrared thermometer on patients who have been exposed to cold. Pediatr Int, 55:767-770.
9. Holt S, Yo J, Karschimkus C et al (2020). Monitoring skin temperature at the wrist in hospitalised patients may assist in the detection of infection. Intern Med J. doi: 10.1111/imj.14748
10. Campbell I (2008). Body temperature and its regulation. Anaesthesia & Intensive Care Medicine, 9:259-263.
11. Gasim GI, Musa IR, Abdien MT, Adam I (2013). Accuracy of tympanic temperature measurement using an infrared tympanic membrane thermometer. BMC Res Notes, 6:194.
12. Bland JM, Altman DG (1999). Measuring agreement in method comparison studies. Stat Methods Med Res, 8:135-160.
13. Suleman M-I, Doufas AG, Akça O, Ducharme M, Sessler DI (2002). Insufficiency in a new temporal-artery thermometer for adult and pediatric patients. Anesth Analg, 95:67-71.
14. Berksoy E, Anıl M, Bıcılıoğlu Y, Gökalp G, Bal A (2018). 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, 11:567-573.
15. Rabbani MZ, Amir M, Malik M et al (2010). Tympanic temperature comparison with oral mercury thermometer readings in an OPD setting. J Coll Physicians Surg Pak, 20:33-6.
16. Vesnovsky O, Li Y, Topoleski L, Zhu L (2017). Modeling of Differences Between Body Core and Forehead Temperatures Measured by Infrared Thermometers. 2017 Design of Medical Devices Conference, American Society of Mechanical Engineers Digital Collection.