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11-03-2013 | General practice | Article

Temporal artery temperature misses pediatric fever detection

Abstract

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medwireNews: Temporal artery thermometry should not be used in place of rectal measurement in the emergency management of very young febrile infants, US researchers warn.

"Temporal artery thermometry is poorly sensitive detecting fever and does not accurately reflect rectal temperature," say Robert Hoffman and team from Albert Einstein College of Medicine in New York.

Temporal artery temperature was found to be only 53% sensitive and 97% specific for detecting a rectal temperature of 100.40 oF (38.00 oC) or greater.

Furthermore, it was just 28% sensitive and 79% specific in detecting the more critical rectal temperature of 102.20 oF (39.00 oC) or greater, the point at which evaluation and treatment for more serious sepsis or bacterial infection is recommended in neonates and young infants.

"Highly impactful decisions… hinge on the presence of a specific temperature," the researchers write in Pediatric Emergency Care. Indeed, a very small difference in temperature reading can mean the difference between a child being evaluated for a potentially life-threatening infection or not.

Hoffman et al explain that temporary artery thermometers replaced rectal thermometers in the triage of all emergency admissions at their institution in 2008. However, rectal assessments continued to be made in the pediatric emergency department (ED), and the treating physicians noted significant discrepancies in temperature readings.

The team therefore conducted a retrospective study of all children younger than 36 months who had presented to the pediatric ED over a 4-month period in 2009. Of 263 charts reviewed, 147 children had a rectal temperature of 100.40 oF (38.00 oC) or greater and 76 had a rectal temperature of 102.20 oF (39.00 oC) or greater.

The mean temporal artery temperature detected was 100.36 oF (37.98 oC) and the mean rectal temperature was 102.36 oF (39.09 oC). The mean difference in temporal and rectal temperature was 1.99 oF (1.11 oC).

"It is impossible to know at what point in the process of developing fever or defervescence our patients were in at the study," the researchers concede, noting there was an average delay of 17.2 minutes between temporal triage and rectal ED assessments.

However, the poor sensitivity of temporal artery thermometry in detecting two critical decision-influencing temperatures, make it unreliable in the ED setting, they suggest.

"We recommend that temporal artery thermometry should not be used in the management of children younger than 36 months if fever or infectious disease is of potential concern," conclude Hoffman et al.

"Further investigation is needed to determine if the same inaccuracy of temporal artery thermometry occurs in patients older than 36 months."

By Sara Freeman, medwireNews reporter

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