This article examined using temporal artery thermometer to detect pediatric fever instead of rectal thermometer. Fever is always an indication of sickness and children have been unable to comply with oral thermometer so rectal route has been used because of its perceived accuracy.
Therefore, temporal artery thermometer (TAT) has become common in pediatric practice. Due to lack of temperature agreement, research has shown that TAT cannot be substituted for rectal thermometry in young children. Though, TAT has been studied as potential screening mechanism for pediatric fever but with inconclusive results This research study addresses use of temporal artery thermometer (TAT) as a screening tool forhigh fever detectionin children ≥91 days and ≤4 years old.
Critique of the background
The authors draw on pre-existing research to formulate the purpose of their own study.The previous studiesindicate thatseveral studies evaluating TAT as a screen to detect rectal feverwhich is defined by the American College of Emergency Physicians ( ACEP) as ≥38 °C, do not support its use. However, some studies have investigated its potential to detect moderate rectal fever at 38.3 °C and 38.5 ° but still there is no clinical significance for moderate fever detection as it does not guide care. Though, the presence of high rectal fever, ≥39 °C, does generally direct clinical decision making as defined by ACEP. The author did cite two studies in which one had evaluated the ability of TAT to detect high fever in children ≤24 months of age whereas other studies did not find TAT screening sufficient to detect high rectal fever. Due to lack of consensus and the desire to avoid rectal assessment if possible, the purpose of this study is to investigate the effectiveness of TAT to detect high rectal fever in children ≥91 days and ≤4 years old. Generally, the review of literature seems comprehensive. These literature reviews helps to understand the importance of the problem and summarizes the current state of research adequately. It lays the solid foundation for the new study of TAT as a screening tool for fever detection which could result in fewer rectal assessments and their associated risks including patient discomfort.In terms of being up-to-date, the review of the literature seems valid.That is, the article includes a well-organized bibliographical reference list of 9 studies and 5 of those studies were published during or after 2009.A vast majority of those studies took place after 2009.
Additionally, as can be seen from the discussion above, the literature seems to be directly related to the development of this study and is involved in the development of the research hypotheses. The purpose of the study is clearly indicated which is to diagnose accurate temperatures using TAT in children ≥91 days and ≤4 years old.
Critique of Methods
The researchers use a design to evaluate rectal and temporal artery (TA) temperatures which was conducted in a 28-bed Emergency Department (ED) in a Magnet community hospital in the Southeastern United States which averages more than 50,000 ED visits annually. During the 17-month study interval (December 2008- April 2010), 3,183 visits were recorded for children ages 91 days to 4 years. In this studymale and female children, aged ≥91 days to 4 years, of any race or ethnicity, were eligible to participate in the study if their parent or guardian understood English. Exclusion criteria included children arriving by emergency medical services, those presenting with life threatening conditions, rectal anomalies, facial trauma, malformation of the temporal area, and the mentally challenged. The sampling design of 239 was enough to enhance the sample representativeness, and it substantiated finding with adequate power for statistical conclusion validity. There was no sampling bias as there was no over or underrepresentation of the population.
Research methods are the techniques researchers use to structure a study and to gather and analyze information relevant to the research question. This is a quantitative research study which involves numeric information that is obtained from a formal measurement and is analyzed statistically. It involves a rigorous and controlled design. This study had specific procedures for measuring temperature; it was first measured rectally than TA temperature was taken.This intervention was managed by five triage nurses who served as data collectors after receiving training, as per manufacturer guidelines.Gender, age, and presenting illness were also collected.
Critique of Results
The result of this research article was shown to prove the hypotheses to be correct. Mean subject age was 1.5 ± 0.77 years, pediatric census at the facility during the study period (χ2 = 2.78, df = 1, p = .095) . Subject mean rectal temperature was 38.05 ± 0.99 °C, while mean TA temperature (37.55 ± 0.8 °C) was 0.5 °C less. Descriptive statistics for the treatment group showed, the difference between mean rectal (38.05 ± .99 °C) and mean TA (37.55 ± .8 °C) temperatures in subjects (N = 239) was significant (p < .0001). Linear regression revealed TAT underestimated rectal thermometry with greater frequency at higher temperatures.
This confirmed the expectation that TA and rectal temperature measurements were not interchangeable as demonstrated by substantial deviation from unity. A TAT sensitivity of 75% and specificity of 85% were determined for detecting high fever (39 °C) — a finding which is clinically unacceptable. Further analysis with sample size ( n = 27) of subjects presenting with injury was analyzed, TAT detected high rectal fever with 100% sensitivity and specificity. This result confirmed that TAT screening for well and injured children has potential for clinical practice by diminishing rectal measurements.
The results were presented clearly and specifically address research question, and hypothesis was tested. The authors set and specify the probability value before addressing the results of the study.
Appropriate descriptive (mean, sensitivity, and specificity) statistics are presented in organized tables and described in the text. This descriptive information is important as they analyze, describe, and allow for presentation which makes it easier to understand the research study. It helps to conduct an appropriately well-designed study leading to valid and reliable results by improving the research designs and producing quality research which can be utilized for formulating the evidence-based guidelines.
On the whole, the results of the research do seem to be indicative.
Critique of Discussion/ Conclusion
For the most part, the discussion and conclusion of this article takes the ideas presented in the results section and makes value statements based upon them.The results are compared to other studies using TAT assessment using their sensitivity and specificity by measuring their strengths and weakness of the studies.
The authors also acknowledged areas where more research was needed because certain topics had not been thoroughly examined before. Toward the end of the discussion, the authors admitted to limitations in this study, such as the small sample size to evaluate TAT as a screen to detect high fever in injured subjects.
The authors felt the subset of study population was small limiting generalizability. Therefore, additional research with a larger sample size of injured children with high rectal fever is necessary to substantiate preliminary finding.Another limitation of this study I feel this study reflected the realistic ED practice setting and not generalized to other setting. The conclusion seems reasonable as the authors recommend future research in guiding adoption of new technology which is based on their statistical as well as practical findings. Implications for EBPIn this research the finding adds to the body of knowledge for utilizing TAT to detect high fever in injured children, and has potential for impacting clinical practice if substantiated by further research.
To adopt new technology in clinical practice more research is needed. This article contributes to our knowledge of new innovational technology but this information cannot be overgeneralized. This study is still at its initial stage so more research is needed before it can be implemented and used for application to EBP.
This study evaluates use of TAT to detect pediatric fever for well and injured children. The strength of this research is the use of TAT as a screening tool for fever detection which could result in fewer rectal assessments and their associated risks including patient discomfort. The weakness of this study is use of TA thermometers vary in usage among practitioners, there is high chance of variance in temperature assessment. Though, this study has potential for impacting clinical practice only if it is substantiated by further research.