Arterial Heat Balance Thermometry at an Exposed Skin Site: Accuracy, Comfort, and Convenience for Patient and Clinician
There has in the past been no method of thermometry that is considered by patients and clinicians to be comfortable, convenient, and accurate. Rectal, oral, axilla, and ear thermometry all have either significant discomfort due to the use of a body cavity, artifactual inaccuracies due to physiological/device phenomena, or both, thus making them less than desirable for the needs of both patient and clinician. The exposed skin eliminates the use of a body cavity, but an accurate method using the skin has heretofore not been demonstrated.
The superficial temporal artery demonstrates the necessary requirements for the skin thermometry method: it is easily accessible, contains no mucous membranes, and notably, it has no or very few arteriovenous anastomoses (AVA). Lack of AVA's means that perfusion rate is reliable under essentially all conditions, and the blood flow is relatively free of vasomotor control in response to thermomoregulatory stimuli. This property is unique to the temporal artery when considering all accessible cutaneous blood vessels. The high and reliable perfusion allows accurate mathematical computations of the heat lost to the environment due to the cutaneous flow, and thus an accurate calculation of the source arterial temperature at the heart.
As a site for temperature measurement, the temporal artery presents many benefits: it poses no risk of injury for patient or clinician, eliminates any need for disrobing or unbundling, and is suitable for all ages. Accordingly, Exergen, incorporating a patented and well-proven arterial heat balance method, developed instrumentation for non-invasive arterial temperature assessment on the skin over temporal artery. The following published peer-reviewed independent studies and papers support the validity of this method.
Peer-Reviewed Published Papers, Abstracts, Letters on Exergen Temporal Artery Thermometry as of August 23, 2021 (101 total)
1. Allegaert K, Casteels K, van Gorp I, Bogaert G. Tympanic, infrared skin, and temporal artery scan thermometers compared with rectal measurement in children: a real-life assessment. Curr Ther Res Clin Exp. 2014 May 8;76:34-8. doi: 10.1016/j.curtheres.2013.11.005. eCollection 2014.
2. Al-Mukhaizeem F, Allen U, Komar L, et al (University of Toronto/Hospital for Sick Children). Validation of the temporal artery thermometry by its comparison with the esophageal method in children. Pediatric Academic Societies Annual Meeting, May 3-6, 2003, Seattle, WA
3. Al-Mukhaizeem F, Allen U, Komar L, et al (University of Toronto/Hospital for Sick Children). Comparison of temporal artery, rectal and esophageal core temperatures in children: Results of a pilot study. Journal of Pediatric and Child Health, Vol 9, No 7, pp 461-465, 2004
4. Asher C and Northington L. Position Statement for Measurement of Temperature/Fever in Children. Journal of Pediatric Nursing, Vol 23, No 3 (June), 2008
5. Artz BA, March KS, Grim RD ( WellSpan Health–York Hospital). Clinical Nurse Specialists empowering staff to improve patient outcomes in temperature measurement: from PI/EBP to nursing research. 2011 National Association of Clinical Nurse Specialists National Conference Abstracts, March 10-12, 2011, Baltimore MD
6. Aydin et al 2020. The Reliability of an Artificial Intelligence Tool, ‘Decision Trees’, in Emergency Medicine Triage. International Journal of Emergency Medicine. DOI: 10.21203/rs.3.rs-127447/v1 Under review
7. Bahorski J, Repasky T, Ranner D, Fields A, Jackson M, Moultry L, Pierce K, Sandell M (Tallahassee Memorial Healthcare). Temperature measurement in pediatrics: a comparison of the rectal method versus the temporal artery method. In Press, Corrected Proof, Available online 24 February 2011, Journal of Pediatric Nursing (2011).
8. Barringer LB, Evans CW, Ingram LL, Tisdale PP, Watson SP, Janken JK (Presbyterian Hospital Matthews). Agreement between temporal artery, oral, and axillary temperature measurements in the perioperative period. J Perianesth Nurs. 2011 Jun;26(3):143-50.
9. Barry L, Branco J, et al. The impact of user technique on temporal artery thermometer measurements. Nursing Critical Care: September 2016 – Volume 11 – Issue 5 – p 12–14.
10. Bartolomé et al 2021. Effect of Handgrip Training in Extreme Heat on the Development of Handgrip Maximal Isometric Strength among Young Males. Int. J. Environ. Res. Public Health 2021, 18, 5240. https://doi.org/10.3390/ijerph18105240
11. Batra P, Saha A, Faridi MM. Thermometry in children. J Emerg Trauma Shock. 2012 Jul;5(3):246-9.
12. Batra P, Goyal S. Comparison of rectal, axillary, tympanic, and temporal artery thermometry in the pediatric emergency room. Pediatr Emerg Care. 2013 Jan;29(1):63-6. doi: 10.1097/PEC.0b013e31827b5427.
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14. Bell 2020. Improving the Accuracy of Temporal Artery Thermometry in Pediatric Direct Care Providers: A Performance Improvement Project (2020). Doctor of Nursing Practice Projects. 12. https://digitalcommons.jsu.edu/etds_nursing/12
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19. Bradley SL, Kwater AP, et al. Is skin temperature measurement in PACU an accurate reflection of core temperature? ASA Abstract A3182, the Anesthesiology Annual Meeting 2016, http://www.asaabstracts.com
20. Bridges E, Thomas K (University of Washington). Noninvasive measurement of body temperature in critically ill patients. Crit. Care Nurse. 2009; 29(3): p. 94-97
21. Burdjalov VF, Combs A, Nachman S, Baumgart S (SUNY at Stony Brook). Non-Invasive infrared temperature assessment of the temporal artery for core temperature determination in premature neonates, Presented American Pediatric Society and the Society for Pediatric Research, May 1, 2001.
22. Callanan D (Christus Santa Rosa Children’s Hospital). Detecting fever in young infants: reliability of perceived, pacifier, and temporal artery temperatures in infants younger than 3 months of age. Pediatr Emerg Care. 2003 Aug;19(4):240-3.
23. Calonder EM, Sendelbach S, Hodges JS, Gustafson C, Machemer C, Johnson D, Reiland L (Abbott Northwestern Hospital). Temperature measurement in patients undergoing colorectal surgery and gynecology surgery: a comparison of esophageal core, temporal artery, and oral methods. Journal of PeriAnesthesia Nursing, Volume 25, Issue 2, April 2010, Pages 71-78
24. Canales AE (Texas Tech University Health Sciences Center). OTC device: temporal scanner TAT-2000C. J Am Pharm Assoc (Wash DC). 2007 Jan-Feb;47(1):112.
25. Carleton E, Fry B, Mulligan A, Bell A, Brossart C. Temporal artery thermometer use in the prehospital setting. Canadian Journal of Emergency Medicine 2012;14(1):7-13.
26. Carr EA, Wilmoth ML, Eliades AB, Baker PJ, Shelestak D, Heisroth KL, Stoner KH (Akron Children's Hospital). Comparison of Temporal Artery to Rectal Temperature Measurements in Children Up to 24 Months, Journal of Pediatric Nursing, In Press, [Epub ahead of print], Jan 25, 2010.
27. Carroll D, Finn C, Gill S, et al (Massachusetts General Hospital). A comparison of measurements from a temporal artery thermometer and a pulmonary artery catheter thermometer. Am J Crit Care. 2004;13:258.
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29. Chiu SH, Anderson GC, Burkhammer MD (University of Akron/Case Western Reserve University). Newborn temperature during skin-to-skin breastfeeding in couples having breastfeeding difficulties. Birth. 2005 Jun;32(2):115-21.
30. Cronin et al 2019. Association Between Magnetic Resonance Imaging in Anesthetized Children and Hypothermia. Pediatric Quality and Safety (2019) 4:4;e181 DOI: 10.1097/pq9.0000000000000181
31. Crossley B. Blanket warmers revisited and temporal thermometers. Biomedical Instrumentation and Technology, March/April 2012 p147.
32. Dursch et al 2018. Tear-Film Evaporation Rate from Simultaneous Ocular-Surface Temperature and TearBreakup Area. Optom Vis Sci 2018;95:5–12. doi:10.1097/OPX.0000000000001156
33. Dybwik K, Nielsen EW. Infrared temporal temperature measurement. Journal of the Norwegian Medical Association 2003; 123: 3025-6.
34. Erdem 2021. The comparison and diagnostic accuracy of different types of thermometers. The Turkish Journal of Pediatrics 2021; 63: 434-442 https://doi.org/10.24953/turkjped.2021.03.010
35. Espenhein A (County Hospital in Herlev, Denmark). Temporal temperature measurement. Sygeplejersken 2006;(17):50-2.
36. Fetzer SJ, Lawrence A (Southern New Hampshire Medical Center). Tympanic membrane versus temporal artery temperatures of adult perianesthesia patients. J Perianesth Nurs. 2008 Aug;23(4):230-6.
37. Foy S, McGillicuddy D, Pompei F, Sanchez L (Beth Israel Medical Center, Boston MA). Body Temperature Surveillance and Reporting in the Emergency Department: A Practical Sentinel for Pandemics and Bioterrorism. Presented at Society for Academic Emergency Medicine Annual Meeting, Phoenix AZ , June 3-6, 2010.
38. Fratto L, Hogan K, Kenney K. Temporal artery thermometry use in pediatric patients in the post-anesthesia care unit. 2012 Research and EBP Abstracts ASPAN's 31st National Conference April 15-19, 2012, Orlando, FL Inf…2012 Research and EBP Abstracts – 8/1/2012 12:43:08 PM.
39. Furlong D, Carroll D, Finn C, Gay D, Gryglik C, Donahue V (2015). Comparison of Temporal to Pulmonary Artery Temperature in Febrile Patients. Dimensions of Critical Care Nursing. 2015 Jan-Feb; 34(1):47-52. doi: 10.1097/DCC.0000000000000090.
40. Greenes DS, Fleisher GR. (Boston Childrens Hospital and Harvard Medical School). Accuracy of a noninvasive temporal artery thermometer for use in infants. Arch Pediatr Adolesc Med, Vol 155, pp 376-381, Mar 2001
41. Greenes DS, Fleisher GR. (Boston Childrens Hospital and Harvard Medical School). When body temperature changes, does rectal temperature lag? Journal of Pediatrics, 02.037, pp 824-826, September 2004.
42. Gunawan M, Soetjiningsih I ( Udayana University, Sanglah Hospital, Denpasar, Indonesia). Comparison of the accuracy of body temperature measurements with temporal artery thermometer and axillary mercury thermometer in term newborns. Paediatr Indones, Vol. 50, No. 2, March 2010.
43. Haddad, L., Smith, S., Phillips, K.D., and Heidel, R.E. (2012). Comparison of temporal artery and axillary temperatures in healthy newborns. Journal of Obstetric, Gynecologic, & Neonatal Nursing, 41, 383-388; doi: 10.1111/j.1552-6909.2012.01367.x
44. Harding C, Pompei F, Bordonaro SF, McGillicuddy DC, Burmistrov D, Sanchez LD. 2019. The daily, weekly, and seasonal cycles of body temperature analyzed at large scale. Chronobiol Int. 2019 Sep 17:1-12. doi: 10.1080/07420528.2019.1663863. [Epub ahead of print]
45. Harding C, Pompei M, Burmistrov D, Pompei F. Overlooked Bias with Thermometer Evaluations Using Quickly Retaken Temperatures in EHR: Axillary, Oral, Temporal Artery, and Tympanic Thermometry. J Gen Intern Med. 2021 Jun 2:1-3. doi: 10.1007/s11606-021-06930-2. Online ahead of print
46. Hirschhorn et al 2021. Exertional Heat Stroke Knowledge and Management among Emergency Medical Service Providers. Int. J. Environ. Res. Public Health 2021, 18, 5016. https://doi.org/10.3390/ijerph18095016
47. Hussain et al 2021. Proper use of noncontact infrared thermometry for temperature screening during COVID‑ 19. Natureportfolio (2021) 11:11832 | https://doi.org/10.1038/s41598-021-90100-1
48. Hargreaves L. (2017) Toolkit for implementation of temporal artery thermometers for neonates. ProQuest Number 10603156, Published by ProQuest LLC (2017)
49. Harper CM ( Royal Sussex County Hospital Brighton, UK). The need for an accurate noninvasive thermometer. Anesth Analg. 2009 Jul;109(1):288; author reply 288-9.
50. Hayes K, Shepard A, Cesarec A, et al. Cost minimisation analysis of thermometry in two different hospital systems. Postgrad Med J Published Online First: 18 January 2017, doi:10.1136/postgradmedj-2016-134630
51. Health Canada (2017). Summary Safety Review – Ear and Forehead (contact) Infrared Thermometers (various brands) – Assessing the potential risk of inaccuracy in children under 2 years old. https://www.canada.ca/en/health-canada/services/drugs-health-products/medeffect-canada/safetyreviews/summary-safety-review-forehead-contact-infrared-thermometers-various-brands-assessingpotential-risk-inaccuracy-children-under-2-years-old.html
52. Hebbar K, Fortenberry JD, Rogers K, Merritt R, Easley K. (Children's Healthcare of Atlanta at Egleston). Comparison of temporal artery thermometer to standard temperature measurements in pediatric intensive care unit patients. Pediatr Crit Care Med. 2005 Sep;6(5):557-61.
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55. Hughes D. Study recommends use of professional temporal thermometer in adults. Oncology Nurse Advisor April 27, 2013.
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61. Kirk D, Rainey T, Vail A, Childs C (University of Manchester, Salford Royal Foundation Trust). Infra-red thermometry: the reliability of tympanic and temporal artery readings for predicting brain temperature after severe traumatic brain injury. Crit Care. 2009 May 27;13(3):R81. [Epub ahead of print]
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65. Leach, K., Ellsworth, M., Ostrosky, L., Bell, C., Masters, K., Calhoun, J., Chang, M. (2021). Evaluation of a telethermographic system for temperature screening at a large tertiary-care referral hospital during the coronavirus disease 2019 (COVID-19) pandemic. Infection Control & Hospital Epidemiology, 42(1), 103-105. doi:10.1017/ice.2020.1254
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68. Lee G, Flannery-Bergey D, Randall-Rollins K, Curry D, Rowe S, Teague M, Tuininga C, Schroeder S (Exempla Lutheran Medical Center). Accuracy of temporal artery thermometry in neonatal intensive care infants. Advances in Neonatal Care, Vol. 11, No. 1, pp. 62-70, Feb 2011.
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71. Mason TM, Reich RR, et al. Equivalence of temperature measurement methods in the adult hematology/oncology population. Clin J Oncol Nurs. 2015 Apr;19(2):E36-40. doi: 10.1188/15.CJON.E36-E40.
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74. Merrill, K. (Seattle Children’s Hospital). Comparison of temporal artery temperature m easurement with standard temperature measurement in critically ill children. American Journal of Critical Care. 2014, May, 23(3), e23.
75. Moore AH, Carrigan JD, Solomon DM, Tart RC. Temporal artery thermometry to detect pediatric fever. Clin Nurs Res. 2015 Oct;24(5):556-63. doi: 10.1177/1054773814557481. Epub 2014 Nov 14.
76. Myny D, DeWaele J, Defloor T, Blot S, Colardyn F (Ghent University Hospital, Ghent, Belgium). Temporal scanner thermometry: a new method of core temperature measurement in intensive care patients. SMJ 2005 45(1): 15-18.
77. Opersteny, Esther et al. Precision, sensitivity and patient preference of non-invasive thermometers in a pediatric surgical acute care setting. Journal of Pediatric Nursing: Nursing Care of Children and Families , 2017, Volume 35 , 36 – 41.
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81. Pittman R and Waters R (CaroMont Health Care, Gastonia, NC). Do our patients have hypothermia? Temporal versus oral thermometers. Journal of PeriAnesthesia Nursing Volume 24, Issue 3, June 2009, Page e18.
82. Pompei F, Pompei M. Non-invasive temporal artery thermometry: Physics, Physiology, and Clinical Accuracy, presented at Medical Thermometry for SARS Detection, SPIE Defense and Security Symposium, available in Conference Proceedings, April, 2004.
83. Pompei F. Insufficiency in thermometer data. Anesth Analg. 2003 Mar;96(3):908-9.
84. Pompei F. RE: A brief report on the normal range of forehead temperature as determined by noncontact, handheld, infrared thermometer. Am J Infect Control. 2006 May;34(4):248-9.
85. Pompei F. Misguided guidelines on noninvasive thermometry. Crit Care Med. 2009 Jan;37(1):383; author reply 383-4.
86. Qadir 2019. How normal body temperature relevance with falooda ice cream loving. MOJ Food Processing & Technology. April 5, 2019
87. Reynolds M, et al. Are temporal artery temperatures accurate enough to replace rectal temperature measurement in pediatric ED patients? J Emerg Nurs. 2012 Nov 8. pii: S0099-1767(12)00329-7. doi: 10.1016/j.jen.2012.07.007. [Epub ahead of print]
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89. Routhier D, Hostler D, Wolfson A, Wheeler M, Reynolds J (University of Pittsburgh). Comparison of temporal artery and oral temperatures in the emergency department. ACAD EMERG MED, May 2006, Vol. 13, No. 5, Suppl. 1, www.aemj.org , p. S99
90. Roy S, Powell K, Gerson LW (Akron Children’s Hospital). Temporal artery temperature measurements in healthy infants, children, and adolescents. Clinical Pediatrics, pp 433-437, June 2003.
91. Sandlin D (Southern Hills Medical Center, Nashville TN). New Product Review: Temporal Artery Thermometry, Journal of PeriAnesthesia Nursing, Vol. 18, No 6 (December) 2003, pp 419-421.
92. Schuh S, Komar L, Stephens D, Chu L, Read S, Allen U (University of Toronto/Hospital for Sick Children). Comparison of the temporal artery and rectal thermometry in children in the emergency department. Pediatric Academic Societies Annual Meeting, May 3-6, 2003, Seattle, WA.
93. Schuh S, Komar L, Stephens D, Chu L, Read S, Allen U (University of Toronto/Hospital for Sick Children). Comparison of the temporal artery and rectal thermometry in children in the emergency department. Pediatric Emergency Care, Vol 20, No. 11, Nov 2004
94. Siberry GK, Diener-West M, Schappell E, Karron RA (Department of Pediatrics, School of Medicine, The Johns Hopkins University). Comparison of temple temperatures with rectal temperatures in children under two years of age. Clinical Pediatrics, pp 405-414, July/August 2002.
95. Smith et al. Comparison of axillary and temporal artery thermometry in preterm neonates. J Obstet Gynecol Neonatal Nurs. 2018 Apr 3. pii: S0884-2175(18)30052-2. doi: 10.1016/j.jogn.2018.02.013. [Epub ahead of print]
96. Sugiarty 2018. Non-Invasive Thermometer: Temporal Artery Thermometer (TAT) Integrated with Electronic Medical Record as the Top-Ranking Temperature Measurement Method for Infants and Children. Health Journal Volume 9, Number 1, April 2018 ISSN 2086-7751 (Print), ISSN 2548-5695 (Online) http://ejurnal.poltekkes-tjk.ac.id/index.php/JK
97. Stern 2018. Taking the temperature of clinical efficiency. Biomedical Instrumentation and Technology. January/February 2018
98. Szmuk P, Curry BP, Sheeran PW, Farrow-Gillespie AC, Ezri T (UT Southwestern and Children's Medical Center, Dallas, Texas). Perioperative temperature audit in a large pediatric hospital. Anesthesiology 2007; 107: A1612.
99. Tan GM, Galinkin JL, Pan Z, Polaner DM. Laryngeal view and temperature measurements while using the perilaryngeal airway (Cobra-PLUS™) in children. Pediatric Anesthesia 2013, Dec; 23(12):1180-6. doi: 10.1111/pan.12266. Epub 2013 Sep 25.
100. Titus MO, Hulsey T, Heckman J, Losek JD (Medical University of South Carolina and Children’s Hospital). Temporal artery thermometry utilization in pediatric emergency care. Clinical Pediatrics, Mar 2009; vol. 48: pp. 190 – 193.
101. Yang WC, Kuo HT, et al. Tympanic temperature versus temporal temperature in patients with pyrexia and chills.Medicine (Baltimore). 2016 Nov;95(44):e5267.