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Forehead Thermometers Miss Some Fevers In Black Patients

In a new study, researchers found forehead thermometers missed 25% of fevers in Black patients.

Forehead Thermometers Miss Some Fevers In Black Patients
Rogelio V. Solis / AP
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During the onset of the COVID-19 pandemic, temporal or forehead thermometers became the go-to for checking for fevers. But now, research shows forehead thermometers are missing fevers in Black patients. 

It adds to a list of health care hurdles they face

"The accuracy of temperature measurement is a big deal, and we need to pay close attention to it," said Dr. Philip Verhoef, a physician-scientist at the University of Hawaii's John A. Burns School of Medicine.

Newsy spoke with two of the researchers from Emory University and the University of Hawaii. They combed through hospital records from 2014-2021 and focused on patients admitted who showed signs of infection. They found forehead thermometers missed almost 25% of fevers in Black patients compared to oral thermometers. Researchers say forehead thermometers' accuracy was much more in line with oral thermometer readings in White patients. 

In triage that missed fever can mean a delay in seeing a doctor. 

"Once the doctor is notified, that's going to start this process where the doctor might see the patient sooner. The doctor might get antibiotics quicker. The doctor might even transfer the patient to an ICU. And so all of these processes of care depend on detecting the fever," said Dr. Sivasubramanium Bhavani, a physician-scientist at Emory University School Of Medicine.

The study only looked at Black and White patient data. It's unclear if the same error happens in other racial or ethnic groups.  But the researchers say this is something they've seen before.  

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"This is not specific to forehead thermometers. I think this is a problem with all infrared technology. We've seen this with pulse oximeters giving inaccurate readings in Black patients," said Bhavani.  

Both medical devices rely on scanners that use infrared light that passes through the skin to measure someone's vitals. A forehead thermometer's reading comes from the heat of the radiation given off by someone's temporal artery. Pulse oximeters read blood oxygen levels based on how the light is absorbed. But several variables can alter infrared readings, like a cold room or the presence of sweat. And skin pigmentation affects how light and infrared radiation is absorbed. It means that if an infrared device isn't calibrated or adjusted to measurement standards for someone with darker skin, those readings could be off. 

"Those are for populations that are historically underrepresented or for whom the health care system has failed them in the first place," said Verhoef. 

These findings add to an ongoing list of medical biases Black patients face. The CDC has noted worse health outcomes for minorities, in everything from pregnancy to cancer to COVID. And even finding a doctor of their own race or ethnicity can be nearly impossible. 2019 data shows just 5% of doctors self-identified as Black.  

It's the same story for mental health care. 

We spoke with clinical psychologist Dr. Patrice Douglas in Rancho Cucamonga, California. Her practice focuses on Black patients.  

"My two private practices, one's insurance-based, one is cash-based. One of my practices, we have over 60 people waiting," said Douglas. "What we're in the process of doing is trying to hire more and more therapists to reach more people that need support. But there's barriers once again, like medical coverage and things like that."

In the meantime, Dr. Bhavani is working to answer more questions about forehead thermometer misreads. His latest research asks if Black patients don't get antibiotics or if their health worsens because their fever was missed. 

And when it comes to which thermometers these doctor-researchers go with:

"I'm going to trust the measurements that I get from an oral thermometer," said Verhoef.