Temporal Artery Thermometry in Pediatric Patients: Systematic Review and Meta-Analysis.
Non-invasive thermometry methods have been used as substitutes for intra-corporeal ones in order to decrease patient discomfort and risk for complications, yet the evaluation of their performance is necessary. Our aim was to synthesize the evidence on the accuracy and precision of temporal artery (TA) thermometry, as well as on its sensitivity and specificity for fever detection. This systematic review and meta-analysis included method-comparison studies, which compared TA temperature measurements with invasive thermometry ones, were published between 2000 and 2018, and were conducted on patients aged <18 years. Thirty articles were selected for inclusion in the final analysis after screening those identified by searches in CINAHL, PubMed, Web of Science, Cochrane Library, EMBASE and Scopus. Quantitative synthesis indicated that pooled mean TA temperature was lower than core temperature by 0.01 °C (95% limits of agreement, -0.06 °C to 0.03 °C). Average summary sensitivity and specificity for fever detection were 0.72 (95% confidence interval, 0.66-0.79) and 0.91 (95% confidence interval, 0.86-0.93) respectively. Subgroup analysis indicated a trend toward larger temperature underestimation in febrile patients and in ages ≤4 years. Despite its satisfactory accuracy, precision and specificity, TA thermometry has low sensitivity when used in pediatric patients, which does not allow satisfactory fever detection. TA thermometry cannot be recommended for replacing rectal temperature measurement methods in children, due to its high proportion of false negative readings during screening for fever.