May-Aug 2021, The Journal of Medicine, Law & Public Health 26 Wrist and Forehead Temperature Measurement as Screening Methods During the COVID-19 Pandemic Imtinan Malawi, Thamer Alsohabani, Mashael Aleidan, Nawa Al shahrani, Adel Karairi, Bandr Mzahim, and Sharafaldeen Bin Nafisah Abstract—Background: Temperature screening checkpoints have become widely distributed during the COVID-19 pandemic, using various contactless methods of temperature measurement, including wrist and forehead measurement. Aim: In this study we aim to investigate the sensitivity and specificity of these two temperature measurement methods – wrist and forehead – compared with the standards of sublingual or axillary measurement. We also aim to investigate the influence of age, gender, device brand and diurnal effect on the temperature reading. Methods: Participants were randomly assigned to one of two groups, each group using a different temperature measurement device. All participants had their forehead and wrist temperature measured, and this was compared to their axillary or sublingual readings. Results: The area under the curve for wrist measurement was 0.49 (95% CI 0.34 and 0.64), p>0.05, with a sensitivity of 46.2% and specificity of 53.3%, while the area under the curve for forehead measurement was 0.70 (95% CI 0.51, 0.89), p<0.05, with a sensitivity of 23.1% and specificity of 76.9%, PPV 1.59% and NPV 97.7%. Conclusion : Wrist and forehead temperature measurement is not accurate in detecting fever during the ongoing COVID- 19 pandemic. Although forehead measurement is also not an ideal method, it nevertheless appears more consistent than wrist measurement. Index Terms—Wrist Temperature, Forehead Temperature, Temperature screenings I. INTRODUCTION From mercury-based to contactless infrared measurement, the advance in thermometer devices has significantly trans- formed fever detection. Contactless measurement is appeal- ingly convenient given the increased community use of fever detection devices during the COVID-19 era. However, de- tection methods vary across different settings, where various improvised methods are used. For instance, the use of an in- frared thermometer on the wrist appears to be widely accepted, despite its design for use on the forehead. Examination of the efficacy of these improvised methods reveals mixed results. In Imtinan Malawi, Thamer Alsohabani, Adel Karairi, Bandr Mzahim, Sharafaldeen Bin Nafisah are with Emergency Department, King Fahd Medical City, Saudi Arabia, e-mail: Imtenanma@gmail.com, e-mail: Thamersoh@windowslive.com, e-mail: akarairi@kfmc.med.sa, e-mail: bmza- him@kfmc.med.sa, e-mail: sbinnafisah@kfmc.med.sa (Corresponding author: Imtinan Malawi) Mashael Aleidan is with Majmma University , Saudi Arabia, e-mail: mashael.aleidan@gmail.com Nawa Al shahrani is with King Khalid University , Saudi Arabia, e-mail: Nawa202059@hotmail.com one study, wrist measurement was unreliable when compared with tympanic membrane measurement [1]; in another, it exhibited higher sensitivity [2]. Forehead measurement, on the other hand, has been criti- cised for its inaccuracy, and it has been suggested that any reading above 35.6 ◦ C should be noted as fever [3], [4]. Such inaccuracy is attributed to the device brand and its variable sensitivity compared with other methods [4], [5]. Therefore, we aim in this study to investigate the sensitivity and specificity of these two temperature measurement methods – wrist and forehead – when compared with the sublingual or axillary standard methods. We also aim to investigate the influence of age, gender, device brand and diurnal effect on the temperature reading. II. METHOD We included all patients – adults and paediatrics – pre- senting to the triage area of the emergency department at King Fahd Medical City, Saudi Arabia, between 6 December 2020 and 17 February 2021. The exclusion criteria were: level 1 classification on the Canadian Triage and Acuity Scale (CTAS), as these patients bypass the vital sign assessment in the triage area. Participation was voluntary, with a 100% participation rate. Data were collected in an online form and included the time of measurement, patients’ age and gender, device brand, the temperature reading of the wrist and fore- head, and either the axillary or sublingual reading. Two devices were chosen, based on their availability on the online market and their use at Saudi Arabia’s various checkpoints. The first device is the handheld Vibeey HW-F7 Digital Non-contact Forehead Infrared Thermometer (Long Hua Xin Qu Shenzhen Guangdong 518109, China), referred to herein as device I. Device II was the handheld Beurer FT 65 Multi-functional Thermometer (Soeflinger Strasse 218 Ulm, 89077 Germany). The device used for sublingual and axillary measurement was the PHILIPS Mindray VS-800, Ver.1 (China). We estimated a sample size of 300 patients for an ac- curate effect size [6]. The standard method of temperature measurement was sublingual for adult patients and axillary for paediatrics; however, crossover of the standard methods between the age groups was allowed. Given the variation in the literature on what constitutes normal body temperature, we used a reference temperature value ranging from 36.0 ◦ C – 37.7 ◦ C [7], [8]. This range