Running head: QUANTITATIVE CRITIQUE

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 surfaces 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 noncontact 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
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

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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.
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

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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).
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

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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 manufacturers
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 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

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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 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).

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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
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 wellwritten 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.

References

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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.