A Comparative Study of 3 Different Methods of Temperature Measurement in Children

The accuracy of body temperature measurement is very important in children. The accuracy and reliability of the forehead skin thermometer (FST) and infrared tympanic thermometer (TT) are inconclusive.

To determine: 1) the mean difference, agreement, and accuracy of body temperature detected in children by FST and ITT, as compared with the gold standard rectal mercury-in-glass thermometer (RMT); and, 2) the cut-off level for FST and ITT in the detection of fever

Children ≤ 2 years old with the chief complaint of "fever" were recruited for this study. Body temperature (BT) was measured by 3 different methods, including FST 5 times; ITT 3 times; and, RMT, 1 time, for each patient. Each measurement method was performed by 3 well-trained staff members, all of whom were blinded to the recorded data of the other methods. The mean difference in body temperature, agreement by Bland-Altman method, and the verified performance of FST and ITT by diagnostic test were assessed.

A total 312 children were recruited. Body temperatures measured by FST and ITT were lower than those measured by RMT, with a mean difference of 1.04°C (p < 0.001) and 1.03°C (p < 0.001), respectively. In subgroup analysis by levels of fever the mean differences between rectal temperature and both forehead and ear temperature were statistically significantly different (p < 0.001) for all levels of fever. Regarding the diagnostic test to verify performance, the data revealed the most practical cut-off point to be 37.0°C for both FST and ITT as compared to the gold standard RMT.

Both FST and ITT were found to be accurate temperature screening methods for daily clinical use. However, the cut-off points to detect fever should be lowered to 37.0°C to be consistent with gold standard measurement.