A comparison of axillary and tympanic membrane to rectal temperatures in children
Abstract
Background Core body temperature measurement is not commonly done in pediatric populations because it is invasive and difficult to perform. Therefore, axillary and tympanic membrane temperature measurements are preferable, but their accuracy is still debatable.
Objective To compare the accuracy of axillary and tympanic temperatures to rectal temperature in children with fever, and to measure the cut-off point for fever based on each temperature measurement method.
Methods A diagnostic study was conducted among feverish children aged 6 months to 5 years who were consecutively selected from the Pediatric Outpatient Clinic, Pediatric Emergency Unit, and the inpatient ward in the Department of Child Health, Cipto Mangunkusumo Hospital (CMH), from December 2014 to January 2015. Subjects underwent three measurements within a two minute span, namely, the axillary, tympanic membrane, and rectal temperature measurements. The values obtained from the examination were analyzed with appropriate statistical tests.
Results The cut-off for fever on axilla was 37.4oC and on tympanic membrane was 37.4oC, with sensitivity 96% (95%CI 0.88 to 0.98) and 93% (95%CI 0.84 to 0.97), respectively; specificity 50% (95%CI 0.47 to 0.84) and 50% (95%CI 0.31 to 0.69), respectively; positive predictive value/PPV 90% (95%CI 0.81 to 0.95) and 85% (95%CI 0.75 to 0.91), respectively; and negative predictive value/NPV 83% (95%CI 0.61 to 0.94) and 69% (95%CI 0.44 to 0.86), respectively. The optimal cut-off of tympanic membrane and axilla temperature was 37.8oC (AUC 0.903 and 0.903, respectively).
Conclusion Axillary temperature measurement is as good as tympanic membrane temperature measurement and can be used in daily clinical practice or at home. By increasing the optimum fever cut-off point for axillary and tympanic membrane temperature to 37.8oC, we find sensitivity 81% and 88%, specificity 86% and 73%, PPV 95% and 91%, and NPV 95% and 91%, respectively.Â
References
Canadian Pediatric Society. Temperature measurement in paediatrics. Paediatr Child Health. 2000;5:273-6.
El-Radhi AS, Barry W. Thermometry in paediatric practice. Arch Dis Child. 2006;91:351-6.
Kocoglu H, Goksu S, Isik M, Akturk Z, Bayazit YA. Infrared tympanic thermometer can accurately measure the body temperature in children in an emergency room setting. Int J Pediatr Otorhinolaryngol. 2002;65:39-43.
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;76:34-8.
Apa H, Gozmen S, Bayram N, Catikoglu A, Devrim F, Karaarslan U, et al. Clinical accuracy of tympanic thermometer and noncontact infrared skin thermometer in pediatric practice: an alternative for axillary digital thermometer. Pediatr Emerg Care. 2013;29:992-7.
Jahanpour F, Azodi P, Zare N. A comparative study on temperature accuracy between tympanic, rectal, and axillary sites. Iran J Med Sci. 2015;33:49-53.
van Staaij BK, Rovers MM, Schilder AG, Hoes AW. Accuracy and feasibility of daily infrared tympanic membrane temperature measurements in the identification of fever in children. Int J Pediatr Otorhinolaryngol. 2003;67:1091-7.
Okposio MM, Abhulimhen-Iyoha BI. Accuracy of mother’s touch in assessing the presence of fever in children. Niger J Paediatr. 2012;39:56-9.
Wammanda RD, Onazi SO. Ability of mothers to assess the presence of fever in their children: implication for the treatment of fever under the ICMI guidelines. Ann Afr Med. 2009;8:173-6.
Alves JG, Correia JB. Ability of mothers to assess the presence of fever in their children without using a thermometer. Trop Doct. 2002;32:145-6.
Graneto JW, Soglin DF. Maternal screening of childhood fever by palpation. Pediatr Emerg Care. 1996;12:183-4.
Banco L, Veltri D. Ability of mothers to subjectively assess the presence of fever in their children. Am J Dis Child. 1984;138:976-8.
Betz MG, Grunfeld AF. ‘Fever phobia’ in the emergency department: a survey of children’s caregivers. Eur J Emerg Med. 2006;13:129-33.
Crocetti M, Moghbeli N, Serwint J. Fever phobia revisited: have parental misconceptions about fever changed in 20 years? Pediatrics. 2001;107:1241-6.
Schmitt BD. Fever in childhood. Pediatrics. 1984;74(suppl):929-36.
Mahajan P, Stanley R. Fever in the toddler-age child: old concerns replaced with new ones. Clin Pediatr Emerg Med. 2008;9:221-7.
Jernigan JA, Siegman-Igra Y, Guerrant RC, Farr BM. A randomized crossover study of disposable thermometers for prevention in Clostridium difficile and other nosocomial infections. Infect Control Hosp Epidemiol. 1998;19:494-9.
Modell JG, Katholi CR, Kumaramangalam S, Hudson E, Graham D. Unreliability of the tympanic thermometer in clinical practice: a comparative study with oral mercury and oral electronic thermometers. South Med J. 1998;91:649-54.
Haddadin RB, Shamo’on HI. Study between axillary and rectal temperature measurements in children. East Mediterr Health J. 2007;13:1060-6.
Morley CJ, Hewson PH, Thornton AJ, Cole TJ. Axillary and rectal temperature measurements in infants. Arch Dis Child. 1992;67:122-5.
Edelu BO, Ojinnaka NC, Ikefuna AN. A comparison of axillary with rectal thermometry in under 5 children. Niger Med J. 2011;52:207-10.
Kline AM, Martin SA. Hazards in neonatal and pediatric thermometry. [cited 2015 January 18]. Available from: http://www.safe-practices.org/pdf/SafePractice2.pdf.
Blainey CG. Site selection in taking body temperature. Am J Nurs. 1974;74:1859-61.
Craig JV, Lancaster GA, Williamson PR, Smyth RL. Temperature measured at the axilla compared with rectum in children and young people: a systematic review. BMJ. 2000;320:1174-8.
Jean-Mary MB, Dicanzio J, Shaw J, Bernstein HH. Limited accuracy and reliability of infrared axillary and aural thermometers in a pediatric outpatient population. J Pediatr. 2002;141:671-6.
Brennan DF, Falk JL, Rothrock SG, Kerr RB. Reliability of infrared tympanic thermometry in the detection of rectal fever in children. Ann Emerg Med. 1995;25:21-30.
Hooker EA. Use of tympanic thermometers to screen for fever in patients in a pediatric emergency department. South Med J. 1993;86:855-8.
Childs C, Harrison R, Hodkinson C. Tympanic membrane temperature as a measure of core temperature. Arch Dis Child. 1999;80:262-6.
Devrim I, Kara A, Ceyhan M, Tezer H, Uludag AK, Cengiz AB, et al. Measurement accuracy of fever by tympanic and axillary thermometry. Pediatr Emerg Care. 2007;23:16-9.
Abdulkadir MB, Johnson B. A comparative study of rectal tympanic and axillary thermometry in febrile children under 5 years of age in Nigeria. Paediatr Int Child Health. 2013;33:165-9.
Authors who publish with this journal agree to the following terms:
Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.
Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.
Accepted 2017-02-22
Published 2017-02-28
