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Reliability of perception of fever by touch
Deepti Chaturvedi1, K Y Vilhekar, Pushpa Chaturvedi
1Department of Pediatrics, Mahatma Gandhi Institute of Medical Sciences, Sevagram, Wardha, Maharashtra, India. drachaturvedi@rediffmail.com
Insights
Caregiver and medical staff touch is unreliable for detecting fever in children. Thermometers are essential for accurate fever diagnosis, as touch can lead to over or under-diagnosis.
Area of Science:
- Pediatrics
- Diagnostic Accuracy
- Clinical Assessment
Background:
- Fever is a common symptom in children, prompting parental concern.
- Assessing fever by touch is a common practice but its diagnostic reliability is questionable.
Purpose of the Study:
- To evaluate the accuracy of tactile assessment by caregivers and medical staff in identifying fever in pediatric patients.
Main Methods:
- A study involving 200 children with reported fever, divided into two age groups (0-1 year and 6-12 years).
- Caregivers (CG) and medical staff (MS) independently assessed for fever by touch, blinded to each other's findings.
- Temperature was objectively measured using calibrated rectal (Group I) and axillary (Group II) thermometers.
Main Results:
- Caregiver touch showed lower sensitivity (70.5%) and specificity (40.9%) compared to medical staff (78.0% sensitivity, 63.6% specificity).
- Medical staff touch was more reliable in affirming or negating fever (NPV 84.8%) than caregiver touch (NPV 72.9%).
- Over-diagnosis of fever was more common with caregiver touch, potentially due to parental anxiety. Abdomen, neck, and forehead were identified as best palpation sites.
Conclusions:
- Tactile assessment is not a valid screening tool for fever in children.
- Routine use of thermometers by medical staff is recommended for accurate fever detection.
- Caregivers should be educated on the importance of using thermometers for fever assessment.
Objective:
To assess the reliability of touch to predict fever in children.
Methods:
200 children who reported with fever formed the study material. Group I consisted of 100 children between 0-1 year of age and Group II consisted of 100 children between 6-12 years of age. Preterm, neonates under warming device, tachypnoeic and hypothermic were excluded from the study. The caregiver (CG) and the medical staffs (MS) response regarding presence or absence of fever by touch was noted in each child. Both were blinded to each other's response. Immediately temperature was recorded by calibrated rectal thermometer in Group I and calibrated axillary thermometer in Group II.
Results:
The CG's touch had a sensitivity of 70.5% specificity of 40.9%, PPV of 38% NPV of 72.9%, PLR was 1.16 and NLR was 0.75. The MS's touch had a sensitivity of 78.0%, specificity of 63.6%, PPV of 38.0% NPV 84.8%, PLR of 2.08 and NLR of 0.36. There is over and under diagnosis of fever by both, the former being more by the CG reflecting the parental anxiety. The MS's touch is better to affirm or negative fever as compared to CG. The best site to palpate for presence of fever was abdomen, neck and forehead.
Conclusion:
Touch is not a valid screening test for fever. It is recommended that a thermometer must always be used by the MS to record fever and CG must be motivated for the same.
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