Oral and Temporal Thermometer Readings Differ in Black Patients

Temporal thermometers are widely used in hospitals, physicians’ offices, and homes to identify fever. Despite their universally accepted uses, there has been little data to determine whether temporal thermometer accuracy differs between races. The recent research letter published in JAMA Network Open determined that temporal thermometers differed from oral thermometers in Black patients.

This research consisted of a retrospective cohort study using data from Emory hospitals between 2014 and 2021. The oral and temporal thermometers used were the Welch Allyn SureTemp Plus and Exergen TAT-5000, respectively.

There were 2,031 Black patients and 2,344 White patients with data on temporal and oral measurements included in this study. The data collected suggested a statistically significant difference between the oral and temporal measurements for Black patients. However, that trend was not apparent among White patients.

Researchers found that the average temporal temperature for Black patients was 36.98 °C, while the average oral temperature was 0.07° higher at 37.05 °C. Conversely, the difference for White patients was only 0.02°.

Furthermore, researchers looked at the prevalence of fever amongst the two races with each thermometer. Temporal thermometers yielded a 10.1% prevalence of fever in Black patients, whereas the prevalence with oral thermometers was 3.1% greater at 13.2%.

The fever prevalence difference between temporal and oral thermometer readings for White patients was less than 1%.

Researchers in the publication explain the danger in this discrepancy, saying, “while there was no significant difference in White patients, healthcare systems routinely use fever cutoffs to trigger notification pathways such as sepsis alerts to systematize timely triage and antibiotic administration. Although the absolute difference between oral and temporal temperatures was small, the findings suggest that this discrepancy combined with commonly used fever cutoffs may lead to fever going undetected in many Black patients.”

The publication suggests that these differences in readings may be due to variations in skin emissivity and pigmentation.

This research follows a discovery earlier this year that pulse oximeters also have racial discrepancies. From these two investigations, one could conclude that there is an apparent racial inequity in the development of medical devices. To combat this, researchers and device developers may consider diversifying clinical trials.

While this research is not definitive, clinicians may consider opting for oral thermometer usage to prevent racial inequities in patient care.