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Comparison of rectal, axillary, and tympanic membrane temperatures in infants and young children
B K Muma1, D J Treloar, K Wurmlinger
1Department of Pediatrics, Henry Ford Hospital, Detroit, Michigan 48202.
Insights
Tympanic membrane and axillary thermometers are unreliable for detecting fever in young children under three. Rectal temperature remains the most accurate measurement for this age group in emergency settings.
Area of Science:
- Pediatric Emergency Medicine
- Medical Device Evaluation
- Clinical Thermometry
Background:
- Accurate fever detection is crucial for diagnosing infections in young children.
- Previous studies show variability in non-invasive temperature measurement methods.
- Tympanic membrane thermometers are commonly used but their reliability in infants is debated.
Purpose of the Study:
- To assess the accuracy and reliability of tympanic membrane thermometers compared to rectal temperatures in detecting fever in pediatric emergency department patients.
- To evaluate the influence of factors like age, otitis media, and ear canal patency on tympanic thermometer accuracy.
Main Methods:
- A prospective study involving 224 children under 3 years old presenting to a pediatric emergency department.
- Sequential temperature measurements were taken at the axillary, rectal, and tympanic membrane sites.
- Temperatures were compared using correlation coefficients and sensitivity analysis.
Main Results:
- Tympanic membrane thermometers showed a correlation of .81 with rectal temperatures, while axillary thermometers correlated at .75.
- The sensitivity of tympanic membrane thermometers in detecting fever was 0.55, compared to 0.48 for axillary measurements.
- Factors such as otitis media and ear canal patency did not significantly affect tympanic thermometer accuracy.
Conclusions:
- Both tympanic membrane and axillary thermometers demonstrate limited reliability in detecting fever in children under 3 years old.
- These non-invasive methods should be used with caution in this age group, with rectal temperature considered a more dependable measure.
- Further research into probe configuration may improve tympanic thermometer performance.
Study Objective:
To evaluate the reliability of a tympanic membrane thermometer in detecting fever in young children presenting to the emergency department.
Setting:
Pediatric emergency department in an urban teaching hospital, DESIGN/MEASUREMENT/PARTICIPANTS: Temperature measurements were obtained sequentially at three body sites in children less than 3 years old presenting to the pediatric ED. Axillary and rectal temperatures were obtained with an electronic thermistor probe (Diatek 500), and tympanic membrane temperatures were obtained with a noncontact, infrared sensing device (First TEMP). Patients were stratified by age, ear canal patency, presence of otitis media, and rectal temperature.
Results:
Of 224 patients enrolled, 87 (39%) were febrile. Overall correlation of axillary and tympanic membrane measurements to rectal for all strata was .75 (P = .001) and .81 (P = .001), respectively. Sensitivity in detecting fever for axillary and tympanic membrane sites was .48 and .55, respectively. Otitis media and ear patency did not influence correlation of tympanic membrane measurements. Low tympanic membrane temperature sensitivity may be a result of probe configuration.
Conclusion:
Tympanic membrane and axillary temperatures should be viewed with caution in children less than 3 years old as neither can detect fever reliably.