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Quantitative Article Critique

Ferris State University

Nicole Cory
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Abstract

This paper is a critique of the article titled Accuracy of Non-contact Infrared Thermometry

Versus Rectal Thermometry in Young Children Evaluated in the Emergency Department for

Fever. The use of infrared thermometry is non-invasive, quick, and painless. Accurate

temperature measurement is essential in providing the appropriate care to pediatric patients in the

emergency department. Infrared thermometry has been found to be less accurate than rectal

thermometry. Temperature readings by infrared thermometers were found to be up to four

degrees higher or lower than readings rectal thermometers. This paper is a critique of several

different aspects of the research study including: data collection methods, sample and design,

hypothesis, purpose and problem statement, review of the literature, and findings of the study.
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Quantitative Article Critique

This paper is a review of the article titled Accuracy of Non-contact Infrared Thermometry

Versus Rectal Thermometry in Young Children Evaluated in the Emergency Department for

Fever. The article describes a research study performed to determine the accuracy of infrared

thermometry which is a device that uses “blackbody radiation emitted from a warm surface and

provides an estimate of that surface’s temperature” (Fortuna et al, 2009).

The thermometer utilized in the study is a handheld thermometer that is touched to the

forehead and then gives a reading. Rectal temperatures have been the standard for taking

temperatures in children, but this is a much more invasive and time consuming procedure than

infrared thermometry (Fortuna et al., 2009).

Temperatures of each participant were taken using both the rectal thermometry method

and the infrared thermometry method (Fortuna et al., 2009). These temperatures were then

compared to determine the accuracy of the infrared thermometry (Fortuna et al., 2009). The

results of the study showed that the infrared thermometer was not accurate when compared to

temperatures that were measured with a rectal thermometer (Fortuna et al., 2009).

Purpose and Problem Statement

The problem being discussed in the article is clearly stated. There are a few instances

where a description of the study is provided such as, “We evaluated the accuracy of a non-

contact infrared thermometer compared with a rectal thermometer”, and “We specifically sought

to determine the agreement between the measurements taken by this device and standard rectal

thermometry” (Fortuna et al., 2009). The article contains information about the population

(young children in the Emergency Department) and contains the variables (rectal thermometry
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and infrared thermometry), but there is no definite statement in the present tense (Fortuna et al.,

2009).

Despite the absence of a specific problem statement the goals and objectives are clear.

The goal of the study is to compare the effectiveness of rectal thermometry and infrared

thermometry (Fortuna et al., 2009). The significance is obvious to me. As an emergency room

nurse I am aware of the problems with obtaining rectal temperatures on children. The process is

lengthy and uncomfortable which causes longer time in triage, delays time to room, and causes

more anxiety in children being seen in the emergency room.

Review of the Literature

Several sources were reviewed by the authors to establish the need for the study as well

as to stress the importance of accurate temperatures in pediatric patients in the emergency

department. Sources such as the article Comparison Between Rectal and Infrared Skin

Temperature in the Newborn were reviewed (De Curtis et al., 2008). The literature reviewed by

the authors dates from the year 1994 to 2008 (Fortuna et al., 2009). There are twelve articles

cited by the authors that discuss thermometry in children (Fortuna et al., 2009). All sources are

relevant to the topic of either pediatric fever or measuring temperature in children (Fortuna et al.,

2009). The citations within the paper are all referenced correctly.

Theoretical Framework

The framework that is most identifiable in this study is a conceptual framework. There is

no specific theory that is related to the researchers’ focus in this study. The framework in this

study is broad. The basis of the study is related to previous research studies and the researchers’

own experiences and in the book Foundations of Nursing Research (2008) this is how the

conceptual framework is described.

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Hypothesis

The authors state that a relationship exists between the variables, but the direction of the

relationship is not stated, therefore, the hypothesis is a nondirectional hypothesis (Nieswiadomy,

2008). The hypothesis merely states, “We specifically sought to determine the agreement

between the measurements taken by this device and standard rectal thermometry” (Fortuna et al.,

2009).

Sample and Design

The authors describe the sample as a convenience sample of 200 patients, ages 1 month

to 4 years that presented to a tertiary pediatric emergency department (Fortuna et al., 2009).

Patients were not included if their condition was too acute “as to preclude participation” (Fortuna

et al. 2009). Patients were also not included if they did not have an English speaking parent or

guardian or if there was a contraindication for rectal thermometry (Fortuna et al., 2009).

Children with abnormalities to the forehead were also not included because this is the area from

which infrared thermometers gain measurement (Fortuna et al., 2009). Other information such

as standard demographics, information regarding antipyretics used prior to measurement, and the

temperature of the room were also recorded (Fortuna et al., 2009).

The study best utilized a convenience sample due to the nature of the study. The study

did not require handpicking or purposive sampling as the study required participants from a

broader category of people. Convenience sampling has been shown to cost less and requires less

time than other sampling methods (Nieswiadomy, 2009). Convenience sampling is often

referred to as “unreliable”, but is often utilized because of the savings on time and funds

(Nieswiadomy, 2009).
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Ethical issues were discussed in the article. The authors state that informed consent was

obtained in each case (Fortuna et al., 2009). The issue of assent is not discussed but the mean

age of children in the study is just over one year old. Assent does not typically become an issue

until the child reaches age seven (Nieswiadomy, 2008). The protocol for the study was also

approved by the local institutional review board (Fortuna et al., 2009).

Data Collection Methods & Instruments

Data collection methods are discussed at length. The authors state that a Welch Allen

SureTemp thermometer was utilized to obtain rectal temperatures (Fortuna et al., 2009). This

thermometer was calibrated using a manufacturer-supplied calibration key (Fortuna et al., 2009).

The thermometer was inserted to 1.5cm into the rectum to obtain rectal temperatures (Fortuna et

al., 2009). Immediately following this measurement, the infrared thermometer was used to

obtain a temperature. The same operator performed both measurements.

Two nurses and two physicians were trained by the authors following manufacturer’s

guidelines regarding both types of thermometer (Fortuna et al., 2009). Only these trained

personnel conducted the measurements utilized in the study (Fortuna et al., 2009).

The study was conducted in a pediatric emergency department (Fortuna et al., 2009).

This setting is appropriate due to the frequent use of thermometry on children in this setting.

Rectal thermometry is most frequently used on small children.

Appropriate measures were taken to ensure the accurate use of the different types of

thermometers. Personnel were trained to utilize the equipment used to obtain the measurements

and only one type of rectal and one type of infrared thermometer was used (Fortuna et al., 2009).

A few variables that I believe could be factors in utilizing the infrared thermometry are the

length of time for the patient to arrive at triage, the outdoor temperature at the time, and the
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amount of clothing on the patient just prior to taking the temperature. Another factor not

discussed is if the temperatures were taken in the same order with every different patient. The

study does not state if rectal temperatures were taken before or after the infrared reading.

Data Analysis

Several statistics were used in the interpretation of the data. The analysis of the data was

done so using the statistical package R 2.6.0 (Fortuna et al., 2009). Correlation was determined.

Descriptive Statistics

The correlation between rectal and infrared thermometry was analyzed. A diagnostic plot

was used to demonstrate the agreement between rectal and non-contact infrared thermometry

(Fortuna et al., 2009). The plot demonstrated only “a moderate agreement between methods”

(Fortuna et al., 2009). Because there was such variance in readings between the rectal

thermometer and the infrared thermometer, the plot demonstrated a broad prediction band

(Fortuna et al., 2009). The evidence suggests that the infrared method was not as accurate as the

rectal thermometer.

Inferential Statistics

The researchers used a statistical package titled R 2.6.0 to “perform tests to consider the

impact of patient age and ambient temperature on measurement agreement” (Fortuna et al.,

2009). The mean age of the children studies was 1.4 years old, and the average rectal and

infrared temperature was 99.6 (Fortuna et al., 2009). Other factors were also considered such as

antipyretic usage prior to arrival and the most common chief complaints (Fortuna et al., 2009).

Findings

The authors discuss the results in a manner that is objective and reflective of the data.

The researchers began the study in the hopes that infrared thermometry would be as accurate as
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rectal thermometry allowing for this technique to be implemented in the pediatric emergency

department. The data did not demonstrate that infrared thermometry was accurate and at times

read either lower or higher than rectal thermometry (Fortuna et al., 2009). The authors state that

the findings are similar to results of other studies such as the research performed by DeCurtis and

colleagues as well as Devrim and colleagues (Fortuna et al., 2009). I believe the study findings

demonstrate just the opposite of what the authors had hope to find, but the recommendations and

findings of the research are discussed with objectivity.

There are a few newer studies on infrared thermometry that have since been conducted.

The article titled Evaluation of Cadi ThermoSENSOR Wireless Skin-Contact Thermometer

Against Ear and Axillary Temperatures in Children became available in April of 2009. Another

study comparing rectal, axillary, and oral temperatures came out in the year 2008.

Conclusions, Implications, and Recommendations

The authors state that the infrared thermometer, “failed to accurately estimate

contemporaneously collected rectal temperatures” (Fortuna et al., 2009). The implications of the

study state that rectal thermometry remains the most reliable measure of temperature in children

(Fortuna et al., 2009). The device utilized in the study did not perform well enough to warrant a

recommendation for its adoption into practice (Fortuna et al., 2009). To this date, children for

which rectal thermometry is contraindicated have no reliable alternative (Fortuna et al., 2009).

The authors discuss the limitations of convenience sampling but state that they did not

find evidence that their sampling affected the results of the study (Fortuna et al., 2009). It is also

noted that the inexperience of the staff could also have been a disadvantage (Fortuna et al.,

2009). They acknowledge that this device is only one of many types of infrared thermometers

and that accuracy may vary by model (Fortuna et al., 2009). Regardless, the authors believed
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that even though infrared thermometry is faster, easier to use, and less invasive, it could not be

recommended based on their findings and that further research is in order (Fortuna et al., 2009).

Conclusion

The article titled Accuracy of Non-contact Infrared Thermometry Versus Rectal

Thermometry in Young Children Evaluated in the Emergency Department for Fever is a well-

written article that depicts the study results in a non-biased manner. The article includes

information on sample and study design that is easy to read. The article gives statistical evidence

in a manner that is concise and well-defined. The implications and evidence are discussed

objectively and clearly.

Rectal thermometry remains the most accurate way to measure temperature in children.

The article states that until a better device becomes available or further studies are done utilizing

other devices, the rectal thermometer remains the preferred method of temperature measurement.

The findings from this study can be utilized in practice and nurses should continue to monitor

temperatures of young children using a rectal thermometer.

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References

Fortuna, E., Camey, M., Macy, M., Stanley, R., Younger, J., & Bradin, S. (2009). Accuracy of

non-contact infrared thermometry versus rectal thermometry in young children evaluated

in the emergency department for fever. Journal of Emergency Nursing, 07(017), 1-4.

Nieswiadomy, R. M. (2008). Foundations of Nursing Research (5th Edition). Alexandria, VA:

Prentice Hall.