METROPOLITAN MEDICAL CENTER

DEPARTMENT OF PEDIATRICS

The Diagnostic Accuracy of Non-Contact Infrared Thermometer as an

Alternative Method in Measuring Body Temperature among the
Pediatric Patients

A Research Paper Presented to

the Philippine Pediatric Society, Inc.
Committee on Research Forum & Workshop

Marlene Adriani Sutanto, MD

Advisers:
Tricia B. Santos, M.D., DPPS
James L. Angtuaco, M.D., DPPS, DPSPC, FPCC

2017
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ABSTRACT

CONTEXT

OBJECTIVE

DESIGN

PARTICIPANTS

RESULTS

CONCLUSIONS
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GLOSSARY OF ABBREVIATIONS

 NCIT: Non-Contact Infrared Thermometer

 DAT: Digital Axillary Thermometer
 OPD: Out Patient Department
 MMC: Metropolitan Medical Center
 PPV: Positive Predictive Value
 NPV: Negative Predictive Value
 IPA: Intra-Pulmonary Arterial
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CHAPTER I
INTRODUCTION

BACKGROUND
Body temperature is one of the most important vital signs in
pediatric. During investigation and diagnosis of patients, accurate
(1)
temperature measurement is of great importance . Measurement of body
temperature is one of the oldest known diagnostic methods and still
remains an important indicator of health and disease, both in everyday life
and in medical care (2).
An ideal thermometer should: accurately reflect the core body
temperature in all age groups; be convenient, easy and comfortable to
use; give rapid results; not cause cross infection among patients; not be
influenced by room temperature; and be safe and cost effective. 3–4 In
practice, every available method has several advantages and
disadvantages.4
The best sites for measuring body temperature are those closest to
the hypothalamus, the temperature regulating center that reflects the
“core” temperature.5 Since the hypothalamus is inaccessible, the core
temperature is generally defined as the temperature measured within the
pulmonary artery.6 Other alternative sites which have been used, including
distal esophagus, bladder, and nasopharynx, are accurate within 0.1-
0.2°C of core temperature.7
However, since these sites are clinically inaccessible, clinicians
have utilized the rectum as a practical site that most closely reflects core
temperature.7 Unfortunately, rectal thermometry has been resented by
many children and their parents 8, leaving axillary thermometry as the only
option in many cases.
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The axillary temperature is easily accessible, safe, hygienic, and

simple. Many clinicians have continued to use and recommend the site for
fever screening9,10
The non-contact infrared thermometer (NCIT) could be a valid
alternative method in measuring body temperature among the pediatric
patients, consisting of a quick and non-invasive method, not requiring
sterilization and not having to be disposable. These reasons make it a
candidate for the screening of febrile individuals (such as, eg, international
travellers) or for temperature recording in children, particularly in hospital
or ambulatory settings,11–13 but some authors found discordant results on
the performance of NCITs.14 We will test this method in some population of
children. We aim at comparing a NCIT with other method digital axillary, in
a population of patient who are consulting in outpatient department at a
private hospital.

DEFINITION OF TERMS
 Body core Temperature; is the temperature of the vital organs
inside the head and trunk which, together with a variable amount of
other tissue, comprise the warm internal core. should be
determined at a site where the measurement is not biased by
environmental temperature. Clinically used sites include the rectum,
the mouth and, occasionally, the axilla.
 Fever is defined as a body temperature ≥38°C (100.4°F), and a
value >40°C (104°F) is called hyperpyrexia.
 Body temperature is defined as the average temperature of human
body. fluctuates in a defined normal range (36.6-37.9°C [97.9-
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100.2°F] rectally), so that the highest point is reached in early

evening and the lowest point is reached in the morning.
 Hypothermia is defined as a core body temperature below 35°C
(95°F). The stage of hypothermia, defined by core temperature, has
a major impact on both recognition and treatment. The most
commonly used definitions found in the literature are as follows:
o Mild – Core temperature 32 to 35°C (90 to 95°F)
o Moderate – Core temperature 28 to 32°C (82 to 90°F)
o Severe – Core temperature below 28°C (82°F)

SIGNIFICANCE OF THE STUDY

The aim in this study is to determine the accuracy of a non-contact
infrared thermometer and its effectiveness in measuring body
temperature among pediatric patients. Non-contact infrared thermometer
can be an alternative method in private clinic or outpatient department
setting in measure body temperature fast, accurate and comfortable with
minimal intervention in children.

STATEMENT OF THE PROBLEM

The main problem of the study is to determine the accuracy of a
non-contact infrared thermometer.
Specifically, this study would like to answer to the following
questions:
1. What is the profiles of the pediatrics from the OPD, MMC in terms
of:
a. Age
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b. Gender
c. Prevalence of Fever based on NCIT detection
2. What is the diagnostic accuracy of non-contact infrared
thermometer in measuring the body temperature among pediatric
patient, in terms of:
a. Sensitivity
b. Specificity
c. Positive Predictive Value (PPV)
d. Negative Predictive Value (NPV)
3. What is the diagnostic accuracy of non-contact infrared
thermometer when grouped according to age:
a. Toddler (ages 1–3 years)
b. preschooler (ages 4–6 years)
c. school-aged child (ages 6–13 years)
d. adolescent (ages 13–19)
4. What is the effectiveness of a non-contact infrared thermometer in
measuring body temperature in comparison with the standard
axillary thermometer among pediatric patient, as a whole and per
age group?

OBJECTIVES OF THE STUDY

General Objective
To determine the accuracy of a non-contact infrared
thermometer.

Specific Objectives
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1.) To evaluate the accuracy of non-contact infrared

thermometer in measuring body temperature among pediatric
patient?
2.) To compare the effectiveness of non-contact infrared
thermometer with the standard digital axillary thermometer in
measuring the body temperature among children.

HYPOTHESIS

1. A non-contact infrared thermometer is accurate as axillary digital

thermometer in measuring the body temperature among pediatric
patient.
2. A non-contact infrared thermometer is more effective in evaluating
body temperature in pediatric patient compared with axillary digital
thermometer.

SCOPE AND LIMITATIONS

Body temperature readings will be collected in pediatric patient who
consulted to outpatient department in a private hospital in Manila.
Conduct by trained nurse, with standard room temperature setting. Data
on temperature readings from digital axillary thermometer (DAT) and non-
contact infrared thermometer (NCIT) will be collected from consented
parents or guardians during the study period. Data will be processed and
presented in terms of prevalence, sensitivity, specificity, positive and
negative predictive values and restrictive operating characteristics (ROC)
curve to compare the diagnostic accuracy of NCIT against the standard
DAT.
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CHAPTER 2
REVIEW OF RELATED LITERATURE

Body temperature measurement is one of the most common

procedures carried out in the Pediatric clinic. It is a crucial clinical
assessment in the care of an acutely ill child.
Before the existence of the thermometer in the 18 th century, physicians
were skilled in assessing core temperature by feeling skin temperature with
their hands.15 Although the scales to quantify temperature in Fahrenheit
and Celsius were developed in the 18th century, the significance of
thermometry for the clinical diagnosis of fever was only recognized
in1868.16
The gold standard for core temperature is the temperature within the
pulmonary artery,16-19 but measurement of intra-pulmonary arterial (IPA)
temperature is invasive, and is not suitable for non-surgical applications.
In humans, non-invasive surrogate measurement of core temperature is
commonly taken at the sublingual site (oral temperature), the axilla, and the
tympanic membrane.20-21 Invasive sites for surrogate measurement include
the rectum, oesophagus, and the GI tract. 20
Rectal temperature is measured by inserting a thermistor rectal
probe or a thermometer about 8 cm past the external anal sphincter. This
is one of the most common methods for measuring core temperature in
the laboratory. Rectal temperature reading is stable and is not influenced
by ambient conditions. However, the invasive nature of rectal temperature
measurement can be traumatic and uncomfortable for children.
Oral temperature is one of the common sites for measuring core
temperature in the clinical setting. Oral temperature fluctuates about 0.4°C
below IPA temperature.22 The sublingual site is easy to access for taking
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oral temperature and oral temperature is responsive to changes in core

temperature.15 However, oral temperature requires about 5 minutes to
achieve a stable temperature reading and its accuracy can be influenced by
breathing rate, which makes it unfeasible to measure oral temperature
during or immediately after physical exertion. The ingestion of beverages
and food prior to temperature measurement can also influence oral
temperature reading. Oral temperature measurement increases the risk of
mouth-to-mouth cross infection and it is not suitable for young children (<5
years old) who have the tendency to bite the thermometer. 21
The axilla temperature is measured under the armpit, near to the
brachial artery. Axilla temperature measurement is practical, non-invasive
and safe, and is suitable for infants and younger children. 17 The sensitivity
of axilla temperature to detect fever is poor, ranging between 27.8% and
33%.23-24 Axilla temperature can be influenced by ambient temperature,
sweat, humidity and the density of hair at the axilla, making it unsuitable
for measurement of body temperature during sports and exercise
participation.
Among the non-invasive temperature measurement, tympanic
temperature probably has the strongest association with core temperature.
The tympanic membrane receives blood supply from the internal carotid
artery, which also supplies blood to the hypothalamus, the region of the
brain that regulates temperature. 15 the accuracy of the tympanic
temperature measurement is highly dependent on the skill of the
technician.25 Compared with IPA temperature, using tympanic temperature
resulted in 21.1% of the patients receiving delayed interventions and
37.8% of the patients receiving unnecessary interventions. 18 Only about
50.9% of tympanic temperature reading was reflective of core
temperature.18
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CHAPTER 3
RESEARCH METHODOLOGY

PARTICIPANTS
The research will take place in Outpatient department of Metropolitan
Medical Center (MMC), a private hospital in Manila, Philippines. All
pediatric patients who came for consult at outpatient department MMC
from August-September 2017 will participate in this study.

POPULATION
• Inclusion criteria:
– Sample will be collected from outpatient department in a
private hospital
– Children aged 1-18 year old
– Male and female children
– Informed consent from parent or guardian of the children
• Exclusion criteria:
– Patients who need immediate care/consult
– Children without informed consent from parent or guardian

STUDY DESIGN
This is an analytic cross-sectional study of pediatric patients form
the OPD, MMC from age 1 to 18 years old where the body temperature
was measured that compares the non-contact infrared thermometer’s
classification of pediatric body temperature with a reference axillary digital
thermometer’s classification.
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PROCEDURE
Before performing the measurements, the participants are asked if
they consumed hot or cold food or drinks within the last half an hour, if not
smoke, not sweating, not exercise, no head compress and sat in constant
room temperature (27-28oc). Calibrate the thermometers every time before
using the instruments. These instruments will hold at room temperature for
at least 10 min,
Sample will be collected in pediatric patients who consulted in
outpatient department of a private hospital in Manila. The parent or
guardian will sign the informed consent. Measure the room temperature
first, with standard room-temperature setting (27-28°c), at the same time
patient will be measured their temperature simultaneously on two site by
trained nurse;
1. Digital Axillary Thermometer: Dry axillary area, place digital
thermometer under the right arm. Read after the signal tone
heard and record.
2. Non-Contact Infrared Thermometer: Push the hair aside, wipe
the sweat, then hold non-contact infrared thermometer at
distance of 3-5 cm from the midpoint of forehead area until the
signal tone was heard (an average of 1–2 s), read and record.

All result will be document with initial name of patient on the table.
Date/Time Initial Age Gender DAT NCIT Signature
name

INSTRUMENTS
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 A Non-Contact Infrared Thermometer. (ProMED, Model number:

PNCT701)
 Digital Axillary Thermometer. (OMRON, Model number: MC-246)

SAMPLE SIZE CALCULATION

Sample size calculation for adequate sensitivity /specificity will be
used to determine the minimum sample size in this study, using the
following formula:
Sample size (n) = Z1-/22 P(1-P) / d2
where: p = expected proportion in population based in previous
studies or pilot studies (pre-determined value for
sensitivity)
Z = standard normal variate (at 5% type 1 error, P<0.05) or
1.96
d = absolute error or precision or 0.05

n = 1.962 x 0.385(1-0.385) = 363.84 or 364 patients

0.052

STATISTICAL ANALYSIS
All data are encoded in Microsoft Excel and processed using SPSS
Version 23 (IBM Corporation, USA). Diagnostic accuracy, such as
sensitivity, specificity, positive (PPV) and negative predictive values (NPV)
will be calculated to determine the diagnostic accuracy of non-contact
infrared thermometer against the gold standard digital axillary
thermometer. Sensitivity is calculated as the proportion of children who
have fever at 37.8oC and above, who are correctly identified by non-
contact infrared thermometer. Specificity, in turn, is the proportion of
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children without fever who are correctly identified by the non-contact

infrared thermometer. Predictive values (PPV and NPV) provide
information about how likely it is that the children have or does not have
fever. PPV pertains to the proportion of children with a positive test results
who have fever; while NPV, with the negative test results who do not have
fever. Receiver Operating Characteristics (ROC) curve will determine the
effectivity of the non-contact infrared thermometer in detecting fever
against the standard digital axillary thermometer. A value of 0.7 and above
indicates that non-contact infrared thermometer is effective tool in
determining body temperature among pediatrics 1 to 18 years old.

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