Accuracy and precision of zero-heat-flux temperature measurements with the 3M™ Bair Hugger™ Temperature Monitoring System: a systematic review and meta-analysis

Aaron Conway*, Megan Bittner, Dan Phan, Kristina Chang, Navpreet Kamboj, Elizabeth Tipton, Matteo Parotto

*Corresponding author for this work

Research output: Contribution to journalReview articlepeer-review

23 Scopus citations


Zero-heat-flux thermometers provide clinicians with the ability to continuously and non-invasively monitor body temperature. These devices are increasingly being used to substitute for more invasive core temperature measurements during surgery and in critical care. The aim of this review was to determine the accuracy and precision of zero-heat-flux temperature measurements from the 3M™ Bair Hugger™ Temperature Monitoring System. Medline and EMBASE were searched for studies that reported on a measurement of core or peripheral temperature that coincided with a measurement from the zero-heat-flux device. Study selection and quality assessment was performed independently using the Revised Quality Assessment of Diagnostic Accuracy Studies tool (QUADAS-2). The Grading of Recommendations, Assessment, Development and Evaluations (GRADE) approach was used to summarize the strength of the evidence. Pooled estimates of the mean bias and limits of agreement with outer 95% confidence intervals (population limits of agreement) were calculated. Sixteen studies were included. The primary meta-analysis of zero-heat-flux versus core temperature consisted of 22 comparisons from 16 individual studies. Data from 952 participants with 314,137 paired measurements were included. The pooled estimate for the mean bias was 0.03 °C. Population limits of agreement, which take into consideration the between-study heterogeneity and sampling error, were wide, spanning from − 0.93 to 0.98 °C. The GRADE evidence quality rating was downgraded to moderate due to concerns about study limitations. Population limits of agreement for the sensitivity analysis restricted to studies rated as having low risk of bias across all the domains of the QUADAS-2 were similar to the primary analysis. The range of uncertainty in the accuracy of a thermometer should be taken into account when using this device to inform clinical decision-making. Clinicians should therefore consider the potential that a temperature measurement from a 3M™ Bair Hugger™ Temperature Monitoring System could be as much as 1 °C higher or lower than core temperature. Use of this device may not be appropriate in situations where a difference in temperature of less than 1 °C is important to detect.

Original languageEnglish (US)
Pages (from-to)39-49
Number of pages11
JournalJournal of Clinical Monitoring and Computing
Issue number1
StatePublished - Feb 2021


  • Anesthesia
  • Measurement
  • Surgery
  • Temperature
  • Zero-heat-flux

ASJC Scopus subject areas

  • Health Informatics
  • Critical Care and Intensive Care Medicine
  • Anesthesiology and Pain Medicine


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