Non-contact infrared versus axillary and tympanic thermometers in children attending primary care: a mixed-methods study of accuracy and acceptability
Open accessAbstract
Background: Guidelines recommend measuring temperature in children presenting with fever using electronic axillary or tympanic thermometers. Non-contact thermometry offers advantages, yet has not been tested against recommended methods in primary care. Aim: To compare two different non-contact infrared thermometers (NCITs) to axillary and tympanic thermometers in children aged ≤5 years visiting their GP with an acute illness. Design and setting: Method comparison study with nested qualitative component. Method: Temperature measurements were taken with electronic axillary (Welch Allyn SureTemp®), electronic tympanic (Braun Thermoscan®), NCIT Thermofocus® 0800, and NCIT Firhealth Forehead. Parents rated acceptability and discomfort. Qualitative interviews explored parents’ experiences of the thermometers. Results: In total, 401 children were recruited (median age 1.6 years, 50.62% male). Mean difference between the Thermofocus NCIT and axillary thermometer was −0.14°C (95% confidence interval [CI] = −0.21 to −0.06°C); lower limit of agreement was −1.57°C (95% CI = −1.69 to −1.44°C) and upper limit 1.29°C (95% CI = 1.16 to 1.42°C). A second NCIT (Firhealth) had similar levels of agreement; however, the limits of agreement between tympanic and axillary thermometers were also wide. Parents expressed a preference for the practicality and comfort of NCITs, and were mostly negative about their child’s experience of axillary thermometers. But there was willingness to adopt whichever device was medically recommended. Conclusion: In a primary care paediatric population, temperature measurements with NCITs varied by >1°C compared with axillary and tympanic approaches. But there was also poor agreement between tympanic and axillary thermometers. Since clinical guidelines often rely on specific fever thresholds, clinicians should interpret peripheral thermometer readings with caution and in the context of a holistic assessment of the child.
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Previous studies using clinical data from hospitals and transit centers have been inconclusive regarding the use and effectiveness of NCITs as a screening method during SARS and influenza outbreaks.
“Overall, previous studies using clinical data from hospitals and transit centers have been inconclusive regarding the use and effectiveness of NCITs as a screening method during SARS and influenza outbreaks.”
From Clinical evaluation of non-contact infrared thermometers (2021) · cites this paper as [7]
The Introduction says prior NCIT studies produced variable results and lacked clear conclusions; it also says most were conducted in paediatric inpatient or other hospital settings. It does not discuss transit-centre screening or NCIT use during SARS or influenza outbreaks, so those parts of the claim are unsupported. (LLM, conf=0.86)
Experimental — accuracy not yet measuredHayward et al. measured the mean difference between NCIT and axillary thermometer temperatures to be −0.14 °C with a 95% confidence interval of −0.21 to −0.06 °C.
“Hayward et al.7 measured the mean difference between NCIT and axillary thermometer temperatures to be − 0.14 °C with a 95% confidence interval of − 0.21 to − 0.06 °C.”
From Clinical evaluation of non-contact infrared thermometers (2021) · cites this paper as [7]
Clinical studies have reported mixed performance in terms of NCIT accuracies.
“Although NCITs may be the primary tools for temperature screening during a pandemic, clinical studies have reported mixed performance in terms of their accuracies5–8.”
From Clinical evaluation of non-contact infrared thermometers (2021) · cites this paper as [7]
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- Authors
- Hayward, G., Verbakel, J. Y., Ismail, F. A., Edwards, G., Wang, K., Fleming, S., Holtman, G. A., Glogowska, M., Morris, E., Curtis, K., & van den Bruel, A.
- Affiliations
- KU Leuven (BE)
- Glasgow Royal Infirmary (GB)
- University of Oxford (GB)
- University Medical Center Groningen (NL)
- University of Bristol (GB)
- ORCID
- Venue
- British Journal of General Practice
- Published
- 2020-03-23
- Volume
- 70
- Issue
- 693
- Pages
- e236-e244
- ISSN
- 0960-1643 (ISSN-L)
- 1478-5242
- PMC
- PMC7098492
- OpenAlex
- W3012591261
- Cited by
- 26
- References
- 29
- Citations by year
- 2026: 3 · 2025: 5 · 2024: 2 · 2023: 3 · 2022: 5 · 2021: 5 · 2020: 3
- FWCI
- 1.95
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- British Journal of General Practice (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- University of Groningen research database (University of Groningen / Centre for Information Technology) (publishedVersion, other-oa)
- Lirias (KU Leuven) (submittedVersion)
- Bristol Research (University of Bristol) (submittedVersion)
- University of Groningen research database (University of Groningen / Centre for Information Technology) (submittedVersion, other-oa)
- Funders
- National Institute for Health and Care Research (16/45/01, CL-2014-13-008, IPF-2018-12-002)
- Topics
- Health Sciences › Medicine › Radiology, Nuclear Medicine and Imaging › Infrared Thermography in Medicine
- Health Sciences › Medicine › Critical Care and Intensive Care Medicine › Thermal Regulation in Medicine
- Physical Sciences › Engineering › Biomedical Engineering › Non-Invasive Vital Sign Monitoring
- Keywords
- tympanic thermometry, body temperature measurement, pediatric fever, thermometer accuracy, acceptability, parental experiences, acute illness in children
- MeSH terms
- Axilla, Body Temperature, Child, Preschool, Cross-Sectional Studies, Female, Fever, Forehead, Humans, Infant, Infrared Rays, Male, Primary Health Care, Sensitivity and Specificity, Thermometers, Tympanic Membrane, Patient Preference
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