Elsevier

The Journal of Pediatrics

Volume 141, Issue 5, November 2002, Pages 671-676
The Journal of Pediatrics

Original Articles
Limited accuracy and reliability of infrared axillary and aural thermometers in a pediatric outpatient population☆,☆☆,★

https://doi.org/10.1067/mpd.2002.127664Get rights and content

Abstract

Objective: To evaluate the accuracy and reliability of infrared axillary and aural thermometers in the outpatient setting. Study design: A prospective observational study of infrared axillary, aural, and digital rectal temperature values from 198 children, aged 3 to 36 months (mean, 1.3 years). Results: Sensitivity and specificity of the axillary thermometer for rectal fever were 63.5% and 92.6%, respectively (diagnostic accuracy, 83.3%); those for the aural thermometer were 68.3% and 94.8%, respectively (diagnostic accuracy, 86.4%). For all patients, the mean biases of the axillary and aural temperatures were −0.33°F and −0.24°F, respectively. The biases of both thermometers' measurements were significantly correlated with rectal temperature (P <.02); thus, as rectal temperature increased, the accuracy of the compared axillary and aural temperature decreased. Underestimation of rectal temperature was greatest among febrile 1- to 3-year-old children (axillary bias, −1.20; aural bias, −0.36). Age was correlated with an axillary temperature bias (P <.01). Conclusion: Axillary and aural infrared thermometers were comparable, albeit significantly different than rectal temperature measurements, particularly as the child's age and rectal temperature increased. These thermometers may be useful as noninvasive screening methods in outpatient settings for children who are at least 3 months old, but rectal values should be used for clinical accuracy. (J Pediatr 2002;141:671-6)

Section snippets

Setting And Study Population

This study was performed at Pediatric Health Associates, a large urban, hospital-based primary care practice located at The Children's Hospital, Boston. A convenience sample of children aged 3 to 36 months who came to our clinical program for either "well child" or acute illness visits were enrolled for a 5-month period. Children with contraindications to rectal temperature measurement or those with known hypothalamic dysfunction were excluded. We obtained written, informed consent from parents

Results

Two-hundred-four sets of measurements were taken on 3- to 36-month-old children who were seen for "well child" or acute illness visits during the 5-month study. The lowest rectal value and corresponding axillary and aural values of each of the 5 subjects who were enrolled twice were discarded; another subject was eliminated because of a missing value, leaving a total of 198 children with temperature measurements for analysis. The mean age of the study population was 1.3 years (range, 3 months-3

Discussion

Since the introduction of thermometry, there has been great debate over the most accurate site of measuring temperature.1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30 Many agree that the sites most reflective of true core temperature are rarely worth the discomfort or risk imposed on the subject, particularly in the nonhospitalized outpatient. These include esophageal, pulmonary artery, bladder, and deep rectal or intrathoracic

Acknowledgements

We gratefully acknowledge Francesca Ambroise, Jennifer Daly, Olivia Depina, Ruth Dubois, Valerie Massiah, and Maritza Ranger-Maxwell for their participation and support of this project. We also thank Dr David Greenes for his thoughtful insights, Victoria Floriani and Lori Rutman for their assistance with manuscript preparation, and David Shapiro for conducting the receiver operating characteristic analysis.

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    ☆

    Supported by The First Years Company.

    ☆☆

    Presented in part at the Pediatric Academic Societies Meeting, San Francisco, California, May 2, 1999.

    ★

    Reprint requests: Henry H. Bernstein, DO, Associate Chief, General Pediatrics, Children's Hospital, 300 Longwood Ave, Boston, MA 02115.

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