









































J Global Clinical Engineering Vol.2 Issue 2: 8-16 ; 2020  8

Received August 1, 2019, accepted December 11, 2019, date of publication February 9, 2020

Is There Sufficient Evidence to Support the Use  
of Temporal Artery and Non-contact Infrared 
Thermometers in Clinical Practice? A Literature Review 

By S. Bolton, E. Latimer, D. Clark

 CHEATA, Clinical Engineering, Nottingham University Hospitals NHS Trust

ABSTRACT

Background and Objective
Accurate measurement of body temperature is a key part of patient observations and can influence important decisions 
regarding tests, diagnosis, and treatment. For routine measurements in hospitals, non-invasive thermometers such as 
tympanic infrared ear thermometers are very widely used even though non-invasive thermometers are not as accurate 
as core thermometry. However, there are known issues regarding the accuracy of these thermometers due to user errors 
including dirty probe covers and not straightening the ear canal. We were therefore keen to understand if there was evi-
dence to support the use of alternative non-tympanic, non-invasive thermometer that could be easily and widely deployed 
across Nottingham University Hospitals NHS Trust.

Material and Methods
A search of the published literature via the NICE HDAS was undertaken to identify the evidence on the use of temporal 
artery (TAT) or non-contact infrared forehead (NCIT) thermometers compared to a core body temperature thermometer 
in a clinical setting. The relevant literature was identified, appraised and summarized.

Results
Fifteen papers described the use of TAT but only 5 reported results that were considered within clinically acceptable limits 
of which 2 included febrile patients. Nine of the 10 studies where TAT was considered not to be within acceptable limits 
included febrile patients. For the NCIT, 3 studies were identified but only 1 reported results within acceptable limits and 
this did not include febrile patients.

Conclusion
A review of the literature for both TAT and NCIT has indicated that in their current form neither is suitable as a replacement 
for oral or tympanic thermometers in clinical practice. In particular, the evidence suggests that they are not acceptable 
methods for detecting temperatures outside the normothermic range and do not detect fever accurately. Known user errors 
with both TAT and tympanic infrared ear thermometers (IRET) could be detracting from the usefulness of the technology.

Keywords – Thermometer, infrared, temporal artery, non-contact, forehead, tympanic, oral, core, virus. 
Copyright © 2021. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY): Creative Commons - Attribu-
tion 4.0 International - CC BY 4.0. The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) 
are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is 
permitted which does not comply with these terms.

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9 J Global Clinical Engineering Vol.2 Issue 2: 8-16 ; 2020

Bolton, Latimer, Clark: Is There Sufficient Evidence to Support the Use  of Temporal Artery and Non-contact Infrared 
Thermometers in Clinical Practice? A Literature Review

INTRODUCTION
Body temperature measurement is a key part of routine 

patient observations in all healthcare settings including 
secondary care and it is one of the 6 components of the 
national early warning score (NEWS) system developed by 
the Royal College of Physicians (https://www.rcplondon.
ac.uk/projects/outputs/national-early-warning-score-
news-2) to standardize the assessment and response 
to acute illness. Temperature monitoring can influence 
important decisions regarding tests, diagnosis, and treat-
ment. It is therefore crucial that thermometers are accu-
rate, reliable and easy to use since inaccurate results may 
lead to a failure in identifying patient deterioration and 
compromise patient safety. The most accurate measure of 
body temperature comes from invasive “core” thermom-
etry options such as pulmonary artery (considered gold 
standard1) but also bladder, nasopharynx or esophageal 
thermistors.2 However, these methods are invasive, po-
tentially high risk and restricted to patients undergoing 
specific procedures and not suitable for everyday use in 
all care settings. There is a range of non-invasive ther-
mometers for obtaining temperatures from peripheral 
body sites including the tympanic membrane, the mouth 
or the axilla. 

Electronic contact non-disposable thermometers that 
incorporate probes specific for use in either the oral cav-
ity (sublingual), axilla or rectum, are commonly used in 
many different healthcare settings, particularly the oral 
cavity. Infrared sensing thermometers such as IRET or 
tympanic, which measure the temperature at the tym-
panic membrane, are also very commonly used across 
all healthcare settings as well as in a domestic setting. 
Other infrared thermometers include the non-contact 
infrared forehead thermometers (NCIT) and the temporal 
artery thermometers (TAT). There are several chemical 
thermometry options such as chemical dots or phase 
change strips though these are generally not as widely 
used as the electronic thermometry options. 

While peripheral body sites are convenient for rapid 
and easy temperature monitoring, not all thermometers 
have clinically acceptable accuracy and published stud-
ies comparing them to core or oral electronic tempera-
ture measurements show substantial variability in the 

methodologies, outcomes and patient populations. In 
particular, the use of peripheral thermometers to detect 
temperatures outside of the normal range (36–38°C) 
is crucial to identify patients who are either hyper- or 
hypothermic and to make the necessary treatment deci-
sions. The wide range of often conflicting data has made 
drawing firm conclusions from these studies difficult but 
there have been various systematic reviews and meta-
analysis2–5 which overall conclude that not all peripheral 
thermometry options are clinically acceptable. Of all the 
thermometry options, non-disposable electronic oral 
thermometers are considered by many to be the most 
accurate reflection of core body temperature3 and can 
be considered as the “gold standard” of non-invasive 
temperature monitoring.6 

The Royal Marsden Manual of Clinical Nursing Proce-
dures (ninth edition, chapter 11: Observations7) includes 
recommendations on the use of different thermometry 
devices to determine patient temperature including the 
use of tympanic thermometers as an acceptable method 
to measure body temperature. Within the NHS, tympanic 
thermometers are widely used non-invasive thermom-
etry devices. However, there are issues associated with 
tympanic thermometers which have been previously 
described8 and by the Marsden Guidelines7, such as 
dirty probe covers and user error (not straightening the 
ear canal) as factors that could contribute to inaccurate 
readings being recorded by these devices. In addition, 
the MHRA also published a Medical Device Alert in May 
20039 that highlighted these 2 issues as contributing to 
low-temperature readings.

Measuring body temperature at peripheral sites, 
therefore, represents a compromise between patient 
acceptance, ease, and speed of recording over tempera-
ture accuracy. The Clinical Engineering department at 
Nottingham University Hospitals NHS Trust (NUH) are 
responsible for the medical equipment that is used across 
the Trust including tympanic ear thermometers for patient 
monitoring. Many of the devices are returned to the de-
partment for cleaning and maintenance due to the issues 
described above. We were therefore keen to understand 
if there was evidence to support the use of alternative 
non-tympanic, non-invasive thermometer that could be 
easily and widely deployed across the Trust to measure 

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Bolton, Latimer, Clark: Is There Sufficient Evidence to Support the Use  of Temporal Artery and Non-contact Infrared 
Thermometers in Clinical Practice? A Literature Review

J Global Clinical Engineering Vol.2 Issue 2: 8-16 ; 2020  10

body temperature in patients. There have been 2 horizon 
scanning/technical scoping articles published covering 
infrared thermometer use in both children (NCIT10) and 
adults (TAT11). The overall conclusions of these 2 reports 
were that the evidence is somewhat equivocal but that 
NCIT could be useful in clinical practice but more research 
is needed. The 2 types of thermometer considered here 
were the TAT and the NCIT.

MATERIALS AND METHOD

Literature Search Strategy
All searches were performed using the NICE HDAS 

(Healthcare Databases Advanced Search) and included 
Pubmed (including Cochrane database), Medline, Em-
base and Cinahl. Searches were restricted to the English 
language and in the last 10 years (2008 onwards). 

Search terms were as follows: Thermometer; Forehead; 
Non-contact; Temporal artery; Thermometer AND non-
contact; Thermometer AND temporal artery; Non-contact 
infrared thermometer.

The output was downloaded to Excel and the output 
reviewed with references being selected according to the 
inclusion/exclusion criteria and availability (see Table 1).

DATA REVIEW
Each paper that was considered to be in scope according 

to the criteria in Table 1 was reviewed and summarized in 
terms of populations, setting, devices used, outcomes and 
detection of hypo/hyperthermia (febrile) patients. The 
conclusion of the authors regarding whether the device 
was clinically acceptable or not was also recorded where 
it was explicitly stated.

FUNDING
No funding was sought for this study.

RESULTS 

Literature Search
For the literature search and review, no age groups 

apart from neonates were excluded to review the widest 
range of literature. The literature search identified 161 
references of which only 16 were considered to be in scope. 
The 16 original clinical research papers were very varied in 
their populations, interventions, comparator (or standard 
reference thermometer), study design, primary outcomes, 
how the data was analyzed and how the results were re-
ported. However, all papers compared the test devices to 
a standard reference method (which was presumed to be 
the most accurate) and most (though not all) concluded 
whether the test devices returned results within defined 
clinically acceptable limits. Most papers discussed the 
limitation of the study which included whether febrile 
patients were included, whether the study included any 
device-specific training and whether user technique was 
considered. Reference methods included invasive core 
measurements such as pulmonary artery, esophageal and 
bladder thermometers as well as non-invasive thermom-
eters such as oral or rectal electronic thermometers. As 
anticipated, no test devices were found to be superior to 
the standard reference device. Some studies included a 
range of devices, not just infrared non-contact devices 
and these were included in the analysis for completeness. 
The key question we asked of the papers was whether 
the evidence supported the use of infrared non-contact 
thermometers in the population being studied and this 
is summarized in Table 2.

TABLE 1. Inclusion/Exclusion Criteria for Infrared Non-con-
tact Thermometer Search

Inclusion Exclusion

Non-contact infrared 
forehead thermometer 
(NCIT)

Measurement of temperature 
in other body locations e.g., 

skin, corneal, umbilicus

Temporal artery thermometer 
(TAT)

No comparison to other 
thermometers

Clinical or professional use in 
humans

Non-clinical studies i.e., 
animals or scientific studies, 

exercise studies

Any age group Large population scanning 
studies e.g., traveller studies

Comparison to core or oral 
thermometers

Use of mercury-in-glass 
thermometers

Original research published 
since 2008



11 J Global Clinical Engineering Vol.2 Issue 2: 8-16 ; 2020

Bolton, Latimer, Clark: Is There Sufficient Evidence to Support the Use  of Temporal Artery and Non-contact Infrared 
Thermometers in Clinical Practice? A Literature Review

TABLE 2. Literature Review of Infrared Non-contact Thermometry

Authors Population Febrile 
Patients

Thermometer type and 
Devices Used in Study Conclusions 

Allegaert 12 Pediatric, n=294 Y

Rectal - Filac 3000, Covidien
Tympanic - Genius 2

TAT - Exergen
NCIT - Thermoflash

YES - TAT agreed with rectal but still 
not optimal 

Barringer 13
Adult patients 

undergoing elective 
surgery, n=86

N
Oral - WelchAlleyn SureTempPlus Model 690
Axilla - WelchAlleyn SureTempPlus Model 690

TAT - Exergen TAT5000

YES - TAT provided temperature 
readings closer in agreement with oral 

readings

Bodkin14 Adult patients, 
n=100 Y

Oral - Dinamap ProCare 400, oral electronic 
non-disposable

TAT - Exergen TAT5000

NO - TAT gave significantly different 
readings to oral electronic thermometer

Brosinski 15

Pediatric <3yrs, 
n=126 geriatric 
>65 yrs, n=125 

unable to use oral 
thermometer

Y TAT - Exergen TAT5000
Rectal - WelchAlleyn SureTempPlus

NO - TAT device not accurate enough 
compared to rectal to be used in the ED

Calonder 16

Patients undergoing 
colorectal or 

gynecology surgery, 
n=23

N

Esophageal - ES400-18 Level 1 Acoustascope 
Esophageal Stethoscope

Oral - WelchAlleyn SureTempPlus Model 678
TAT - Exergen TAT5000

YES - TAT were accurate for 
temperature assessment but tended to 

over-estimate temperature compared to 
esophageal 

Counts 17
Acutely ill patients 
aged > 18 years old, 

n=48
Y

Oral - WelchAlleyn SureTempPlus Model 690
Oral - Disposable digital oral electronic 

thermometer: Medichoice (Mesure Technology 
Co,

TAT - Exergen TAT5000

NO - TAT was judged to exceed 
clinically acceptable limits

Forrest 18

Febrile and afebrile 
pediatric patients, 36 
months and under, 

n=85

Y

Rectal - WelchAlleyn SureTempPlus Model 
690

Axilla - WelchAlleyn SureTempPlus Model 690
TAT - Exergen TAT5000

NO - TAT cannot be recommended to 
detect fever in pediatric populations

Gates 19

Adults, multiple 
myeloma, inpatient 
unit bone marrow 

transplantation. 

Y
Oral - WelchAlleyn SureTempPlus Model 690

Tympanic - Genius 2
TAT - Exergen TAT5000

NO – TAT over-estimates temperature

Hamilton 20

Adult febrile (n=11) 
and afebrile (n=8)
Pediatric febrile 

(n=53) and afebrile 
(n=99) 

Y

Oral - WelchAlleyn SureTempPlus Model 692
Tympanic - Braun Thermoscan 4520

NCIT - Visiomed SAS Thermoflash LX-26
Forehead - Beurer FT 60 infrared contact 

forehead thermometer
TAT - Exergen TAT-2000C

Forehead - Chicco Thermo Touch Plus contact 
forehead thermometer

NO - TAT or NCIT (or other forehead 
thermometers) not considered 

acceptable



Bolton, Latimer, Clark: Is There Sufficient Evidence to Support the Use  of Temporal Artery and Non-contact Infrared 
Thermometers in Clinical Practice? A Literature Review

J Global Clinical Engineering Vol.2 Issue 2: 8-16 ; 2020  12

Authors Population Febrile 
Patients

Thermometer type and 
Devices Used in Study Conclusions 

Hamilton 21
Febrile (n=94) and 

afebrile (n=111) 
children

Y

Oral - WelchAlleyn SureTempPlus 
Tympanic - ThermoScan® PRO 4000 

prewarmed tip ear thermometer
TAT - Exergen TAT5000

NO - TAT not acceptable. Compared 
to reference, TAT gave statistically 

significantly different readings

 Langham 22

Patients undergoing 
laparoscopic surgery. 

Aged 18-80 yrs, 
n=50

N

Bladder - Foley catheter (Mon-a-therm 
Foley-Temp)

Esophageal – esophageal stethoscope with 
thermistor (Mon-atherm EST)

TAT- Exergen TAT-5000
Tympanic - FirstTemp Genius 3000A

Skin-surface thermocouple (Monatherm 6130)
Skin - Liquid-crystal display strip (Crystaline 

Moving Line)
Oral and Axilla - Electronic thermometer 

(IVAC TempPlus II 2080A)
Deep thermometer (CoreTemp CTM-205 with 

a PD-51 probe)

NO – TAT only had reasonable 
correlation to core. Electronic oral 

thermometry was the most accurate 
and reliable device compared to the 

reference

Lunney 23 Hemodialysis 
patients Y

Thermometer in Fresenius 5008 hemodialysis 
machine,

TAT - Exergen TAT5000

NO - TAT method exceeds the 
clinically acceptable reference method 

Marable 24
Adult male patients, 

critical care unit, 
n=69

Y

Oral - WelchAlleyn SureTempPlus Model 692
Axilla - WelchAlleyn SureTempPlus Model 692

TAT - Exergen TAT5000, forehead and ear
TAT - Exergen TAT5000, forehead only

TAT - Exergen TAT5000, ear only

NO – The results do not favour 
temporal artery scanning in adult 

critical care patients

Opersteny 25

Pediatric patients 
aged 0–17 years, 
inpatient surgical 

units, n=298 

Y
Oral - WelchAlleyn SureTempPlus Model 692
Axilla - WelchAlleyn SureTempPlus Model 692

TAT - Exergen TAT5000

YES - TAT is an acceptable temperature 
measure that could substitute oral or 

axillary thermometers

Sollai 26

Healthy term 
(n=119) and 

preterm newborns 
(n=70) nursed in 

incubators 

N
Axilla – Sanitas digital thermometer

Tympanic - Thermoscan Pro 4000
NCIT - Thermofocus 800

YES - NCIT is a promising, quick 
non-invasive and accurate method to 
measure temperature in newborn and 

preterm babies

Stelfox 27

18 years or more, 
expected to stay 
in ICU for 24hr 
or more. n=736 

readings from 14 
patients

Y
Bladder - Level 1® Foley Catheter 

temperature Sensor, Smiths Group PLC
TAT - Exergen TAT5000

YES - TAT closely agreed with 
the bladder thermometer for 

normothermic measurements but less 
agreement for temperatures < 36°C or 

>38.3°C

Bold indicates Study reference devices.



13 J Global Clinical Engineering Vol.2 Issue 2: 8-16 ; 2020

Bolton, Latimer, Clark: Is There Sufficient Evidence to Support the Use  of Temporal Artery and Non-contact Infrared 
Thermometers in Clinical Practice? A Literature Review

The results from all 16 papers were collated and sum-
marized by device including which thermometer was used 
as a reference standard, whether the TAT or NCIT were 
considered as the next best compared to the standard (a 
frequently reported outcome) and whether it was con-
sidered to be within clinically accepted limits (which was 
considered to be +/- 0.5°C [1°F]) unless otherwise stated, 
though it was not always explicitly stated.

Of the 15 papers that included the TAT, only 5 of these 
studies12,13,16,25,27 reported results that were considered to 
be within clinically acceptable limits or were not statisti-
cally significantly different from the reference device and 
would support the use of TAT in clinical practice. Of these 
5 studies, only 2 reported that the TAT could accurately 
detect fever.12,25 Of the remaining 3 papers, Stelfox et al.27 

included febrile patients but reported that the TAT was only 
acceptable for patients within the normal range (36–38°C) 
as there was less agreement for temperatures below 36°C 
and temperatures greater than or equal to 38°C. The other 
2 papers13,16 concluded that TAT was acceptable but they 
did not include febrile patients in their study. 

In the 10 studies where TAT was judged to be not 
acceptable, 9 of the studies included patients with fever 

indicating that TAT did not perform accurately to identify 
fever in a wide range of patient populations. 

There were only 3 studies that compared NCIT to a 
reference thermometry measurement. The study by Sol-
lai26 using the ThermoFocus device reported results that 
were considered acceptable compared to the reference 
standard. However, the reference standard was digital 
axillary in neonates and the study did not include febrile 
babies. Both studies 13,20 where NCIT devices were not 
considered acceptable included febrile patients indicating 
that the NCIT is not acceptable for detecting temperatures 
outside the normothermic range.

DISCUSSION
A search and review of the published literature was 

undertaken to determine if there is sufficient evidence to 
support the use of non-tympanic non-invasive thermometers 
in a hospital setting (Table 3). Two types of thermometer 
were considered: TATs and non-contact infrared forehead 
thermometers. The literature reviewed focused on the 
studies comparing TAT and NCIT with either invasive core 
thermometry or standard oral electronic thermometry. 

TABLE 3. Literature Review Summary by Device

Thermometer type: Device Manufacturer No . of 
studies

Used as reference 
standard

Next best to 
ref device

Outside 
accepted 

limits

Oral: SureTempPlus WelchAlleyn 8 7 1

Axilla: SureTempPlus WelchAlleyn 4 1 2 1

Rectal: SureTempPlus WelchAlleyn 3 2

Esophageal: Stethoscope with temperature sensor Mon-a-therm

Smiths Medical 2 2

Bladder: Foley catheter Mon-a-therm

Smiths Medical 2 2

Axilla: Sanitas Dx Sanitas 1 1

Oral: Dinamap ProCare 400 Dinamap 1 1

Rectal: Filac 3000 Covidien 1 1

Dialysis machine, 5008 Fresenius 1 1

TAT: TAT5000/2000 Exergen 15 5 10

Tympanic:Genius 2 Covidien 3 1 2

Tympanic: Thermoscan PWT Braun 2 2



Bolton, Latimer, Clark: Is There Sufficient Evidence to Support the Use  of Temporal Artery and Non-contact Infrared 
Thermometers in Clinical Practice? A Literature Review

J Global Clinical Engineering Vol.2 Issue 2: 8-16 ; 2020  14

Despite a decent sized body of evidence, including clinical 
studies for the TAT, the results do not support their use 
in a clinical setting with many studies reporting that they 
were inaccurate outside of the normal body temperature 
range. This conclusion is in agreement with meta-analyses 
conducted by Geijer28 and Niven.2 The evidence for the 
NCIT was more limited with very few papers meeting the 
inclusion criteria and also did not support their use in a 
clinical setting for the same reasons. 

One of the key issues was the relatively small number 
of papers meeting the inclusion/exclusion criteria used in 
our study which then described a wide range of settings, 
populations, devices, comparator (standard reference) 
devices, outcomes including detection of fever and how 
the results were analyzed and reported. This wide varia-
tion in reporting and outcomes was also identified and 
discussed as a drawback in the meta-analysis.2–5 There 
was some variability in standard reference methods in 
the papers reviewed and none of the studies used an 
intravascular measure of temperature (gold standard) 
although one study23 did use the thermometer incorporated 
in the dialysis machine. Typical invasive thermometry 
options included in these studies were either bladder or 
esophageal thermometers. However, the most common 
reference method was an electronic non-disposable oral 
thermometer such as the WelchAlleyn SureTempPlus. The 
outcomes, analysis, and reporting also differed between 
the studies and varied from reporting the mean differ-
ences to calculated limits of acceptability. Where febrile 
patients were included, the reporting varied from false 
negative or positive rates to misclassification percentages. 
Due to this variability, we chose to record whether the 
authors would recommend either the TAT or the NCIT 
device being studied for use in clinical practice. 

Overall, from the 15 papers the described the use of 
TAT devices, the device was in general considered to 
be outside the clinically acceptable limits. This is also 
highlighted and discussed in the recently published 
meta-analysis and reviews published.2,4,5 The majority of 
studies that found TAT to be acceptable did not include 
patients outside the normal range and it was shown that 
there was less agreement for temperatures below 36°C 
and temperatures greater than or equal to 38°C. These 
studies indicate that TAT is acceptable for normothermic 

patients only as has already been highlighted by the meta-
analyses. However, several studies found TAT devices to 
be more acceptable to patients, especially children, and 
more likely to record a reading at the first attempt.13,25

There were fewer papers involving the NCIT and these 
devices were specifically excluded from the meta-analysis of 
Niven.2 Similar to the TAT, these thermometers performed 
reasonably well in normothermic ranges but not outside 
this range and the study where the results were within 
acceptable limits did not contain any febrile patients. A 
study by Fletcher29 looked at 9 NCITs (all unnamed, 3 
groups according to specification) which were calibrated 
using 2 NPL standard blackbody sources with emissivi-
ties >0.999. NCITs from 2 of the groups were shown to 
give large measurement errors with readings falling far 
outside both the manufacturer’s stated uncertainties. A 
third group of NCIT performed well, with all the results 
falling within the stated uncertainties. Overall, more evi-
dence needs to be gathered as to the clinical acceptability 
of the NCIT devices in all settings but there is potential 
for NCITs to provide a rapid, hygienic and non-invasive 
means of measuring temperature, particularly in children.

The evidence indicates that the TAT and NCIT in their 
current form are not well suited to detecting tempera-
tures outside the normal range. Failure to detect fever 
has significant consequences for patient care if the fever 
is missed and the patient is not treated accordingly or 
if fever is falsely detected, it may result in unnecessary 
clinical interventions. This is more critical in patients with 
cancer where detection of fever can be an indication of a 
potentially life-threatening infection.19

For both types of thermometer, both calibration and 
training to reduce user error was discussed as being a 
key factor in obtaining accurate and consistent readings. 
Three of the studies13,19,24 specifically mentioned device 
training and 7 of the studies16–20,26,27 documented that 
the devices were calibrated by the Clinical Engineering 
department. While there was no specific literature on 
the usability or training for NCIT, there has been a pub-
lication detailing the training and use of TAT in clinical 
practice. Barry et al.30 undertook an observational study 
to look at the impact of user technique on the accuracy of 
TAT measurements. Despite documented training on the 



15 J Global Clinical Engineering Vol.2 Issue 2: 8-16 ; 2020

Bolton, Latimer, Clark: Is There Sufficient Evidence to Support the Use  of Temporal Artery and Non-contact Infrared 
Thermometers in Clinical Practice? A Literature Review

correct technique, only 39% of users demonstrated the 
correct technique and returned acceptable temperature 
measurements. The remaining 61% failed to demonstrate 
correct technique and recorded statistically significantly 
lower temperatures. The most common mistake was to 
scan only the forehead and to miss either the temple 
or under the ear. Similar user mistakes have also been 
documented with tympanic thermometers where users 
fail to straighten the ear canal to direct the IR beam to 
the correct quadrant of the tympanic membrane.8,9,31  It is 
interesting to speculate how the manufacturers could use 
this information to redesign their products to eliminate 
the user error issues and thereby improve the intuitive 
use of the device which would in turn reduce the need for 
regular training to make sure the device is used appropri-
ately. This would then enable a more accurate evaluation 
to determine whether, when used easily and correctly, 
the thermometers can measure body temperature within 
clinically acceptable limits and could be considered as a 
long-term option for thermometry.

CONCLUSIONS
A review of the literature for both TAT and NCIT has 

indicated that in their current form neither is suitable 
as a replacement for oral or tympanic thermometers in 
clinical practice. In particular, the evidence suggests that 
they are not acceptable methods for detecting tempera-
tures outside the normothermic range and do not detect 
fever accurately. Known user errors with both TAT and 
tympanic IRET could be detracting from the usefulness 
of the technology. 

ACKNOWLEDGEMENT
The authors would like to thank Rob Furby and David 

Williams for their expert input and advice during this 
project.

GRANT SUPPORT
No grant funding was obtained for this study.

REFERENCES

1. Akata T, Setoguchi H, Shirozu K and Yoshino J. Reliabil-
ity of temperatures measured at standard monitoring 
sites as an index of brain temperature during deep 
hypothermic cardiopulmonary bypass conducted for 
thoracic aortic reconstruction. J Thorac Cardiovasc 
Surg 2007;133:1559–65

2. Niven DJ, Gaudet JE; Laupland KB, et al. Accuracy of 
peripheral thermometers for estimating temperature: 
a systematic review and meta-analysis. Ann Intern 
Med 2015;163(10);768–77.

3. Jefferies S, Weatherall M, Young P et al. A systematic 
review of the accuracy of peripheral thermometry in 
estimating core temperatures among febrile critically 
ill patients. Crit Care Resusc 2011;13:194–99

4. Kiekkas P, Stefanopoulos N, Bakalis N, et al. Agreement 
of infrared temporal artery thermometry with other 
thermometry methods in adults: systematic review. 
Journal Clin Nursing 2016;25 (7-8);894–905.

5. Ryan-Wenger N, Sims M, Patton RA et al. Selection 
of the most accurate thermometer devices for clini-
cal practice: Part 1: Meta-analysis of the accuracy of 
non-core thermometer devices compared to core body 
temperature. Pediatric Nursing 2019;44(3):116–33.

6. Gates D, Horner V; Bradley L, et al. Temperature mea-
surements: comparison of different thermometer 
types for patients with cancer. Clinical J Oncol Nurs 
2018;22(6);611–17.

7. Royal Marsden Manual of Clinical Nursing Procedures 
(ninth edition), chapter 11: Observations http://www.
rmmonline.co.uk/manual/c11-sec-0002#c11-sec-0002

8. Davie A; Amoore J. Best practice in the measurement 
of body temperature. Nursing Standard (Royal College 
of Nursing (Great Britain) 1987;2010;24(42);42–49.

9. The Pharmaceutical Journal. Warning on the use of 
infrared thermometers. [Internet] 2003;270 (7248); 
640. Available at: https://www.pharmaceutical-journal.
com/pj-online-news-warning-on-use-of-infrared-
thermometers/20009407.article

10. Horizon Scan Report 0025. November 2013. NIHR 
Diagnostic Evidence Co-operative Oxford. Available at: 
https://www.community.healthcare.mic.nihr.ac.uk/

http://www.rmmonline.co.uk/manual/c11
http://www.rmmonline.co.uk/manual/c11
https://www.pharmaceutical-journal.com/pj-online-news-warning-on-use-of-infrared-thermometers/20009407.article
https://www.pharmaceutical-journal.com/pj-online-news-warning-on-use-of-infrared-thermometers/20009407.article
https://www.pharmaceutical-journal.com/pj-online-news-warning-on-use-of-infrared-thermometers/20009407.article
https://www.community.healthcare.mic.nihr.ac.uk/reports-and-resources/horizon-scanning-reports/hs


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reports-and-resources/horizon-scanning-reports/
hs-report-0025.

11. Technologies Scoping Report. Number 11, December 
2012. Health Improvement Scotland. Available at: http://
www.healthcareimprovementscotland.org/our_work/
technologies_and_medicines/earlier_scoping_reports/
technologies_scoping_report_11.aspx

12. Allegaert K, Casteels K, van Gorp I et al. Tympanic, 
infrared skin, and temporal artery scan thermometers 
compared with rectal measurement in children: a 
real-life assessment. Curr Therapeutic Res, Clin Exper 
2014;76:34–38.

13. Barringer LB, Evans CW, Ingram LL et al. Agreement 
between temporal artery, oral, and axillary temperature 
measurements in the perioperative period. J Perianesth 
Nurs 2011;26 (3):143–50.

14. Bodkin RP, Acquisto NM, Zwart JM, et al. Differences in 
noninvasive thermometer measurements in the adult 
emergency department. Am J Emerg Med 2014;32 
(9):987–89.

15. Brosinski C, Valdez S, Riddell, A et al. Comparison 
of temporal artery versus rectal temperature in 
emergency department patients who are unable to 
participate in oral temperature assessment. J Emerg 
Nurs 2018;44(1):57–63

16. Calonder EM, Sendelbach S, Hodges JS, et al. Tempera-
ture measurement in patients undergoing colorectal 
surgery and gynecology surgery: a comparison of 
esophageal core, temporal artery, and oral methods. 
J Perianesth Nursing 2010;25(2):71–78.

17. Counts D, Acosta M, Holbrook H, et al. Evaluation of 
temporal artery and disposable digital oral thermometers 
in acutely ill patients. Medsurg Nurs 2014;23(4):239.

18. Forrest AJ, Juliano ML, Conley SP, et al. Temporal artery 
and axillary thermometry comparison with rectal 
thermometry in children presenting to the ED. Am J 
Emerg Med 2017;35(12):1855–58.

19. Gates D, Horner V, Bradley L, et al. Temperature mea-
surements: comparison of different thermometer 
types for patients with cancer. Clin J Oncol Nursing 
2018;22(6):611–17.

20. Hamilton PA, Kasbekar RS, Monro R. Clinical perfor-
mance of infrared consumer-grade thermometers. J 
Nurs Measure 2013;21(2):166–77.

21. Hamilton PA, Marcos LS, Secic M. Performance of in-
frared ear and forehead thermometers: a comparative 
study in 205 febrile and afebrile children. J Clin Nurs 
2013;22(17–18):2509–18.

22. Langham GE, Maheshwari A, Contrera K, et al. Nonin-
vasive temperature monitoring in postanesthesia care 
units. Anesthesiology 2009;111(1):90–96.

23. Lunney M, Tonelli B, Lewis R, et al. A comparison of 
temporal artery thermometers with internal blood 
monitors to measure body temperature during he-
modialysis. BMC Nephrol 2018;19(1):137.

24. Marable K, Shaffer LE, Dizon V, et al. Temporal artery 
scanning falls short as a secondary, noninvasive ther-
mometry method for trauma patients. J Trauma Nurs 
2009;16(1):41–47.

25. Opersteny E, Anderson H, Bates J, et al. Precision, 
sensitivity and patient preference of non-invasive 
thermometers in a pediatric surgical acute care set-
ting. J Pediatr Nursing 2017;35:36–41.

26. Sollai S, Dani C, Berti E, et al. Performance of a non-
contact infrared thermometer in healthy newborns. 
BMJ Open 2016;6(3);e008695.

27. Stelfox HT, Straus SE, Ghali WA, et al. Temporal artery 
versus bladder thermometry during adult medical-
surgical intensive care monitoring: an observational 
study. BMC Anesthesiol 2010;10:13.

28. Geijer H, Udumyan R, Lohse G, et al. Temperature mea-
surements with a temporal scanner: systematic review 
and meta-analysis. BMJ Open 2016;6(3):e009509.

29. Fletcher T, Whittam A, Simpson R, et al. Comparison 
of non-contact infrared skin thermometers. J Med 
Engineer Technol 2018;42(2);65–71.

30. Barry L, Branco J, Kargbo N, et al. The impact of user 
technique on temporal artery thermometer measure-
ments. Nurs Crit Care 201611(5):12–14.

31. Yeoh WK, Lee JKW, Lim HY, et al. Re-visiting the tym-
panic membrane vicinity as core body temperature 
measurement site. PLoS ONE 2017;12(4):e1074120.

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