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Performance of axillary and rectal temperature measurement in private pediatric practice
Jan Teller1, Reto Bernasconi2, Giacomo D Simonetti3,4
1Private Pediatric Practice, Langnau I.E., Switzerland.
Insights
Axillary temperature readings in infants are consistently lower than rectal measurements, with wide agreement limits. While useful for fever screening, critical temperature checks require more reliable methods.
Area of Science:
- Pediatrics
- Clinical Thermometry
- Infant Health
Background:
- Rectal temperature measurement has been the traditional standard for infants.
- Current guidelines recommend axillary measurements due to better acceptance.
Purpose of the Study:
- To evaluate the clinical reliability of axillary temperature measurements in infants.
- To compare axillary and rectal temperature readings in a pediatric practice setting.
Main Methods:
- 169 infants with fever underwent prospectively axillary and rectal temperature measurements.
- Digital thermometers were used, with multiple readings averaged for axillary and rectal sites.
- Bland-Altman plots were utilized to assess agreement between measurement methods.
Main Results:
- Axillary temperatures (median 36.9°C) were significantly lower than rectal temperatures (median 38.2°C; p < 0.0001).
- The mean bias was 1.15°C, with wide limits of agreement (0.32 to 1.98°C).
- Axillary thermometers demonstrated high sensitivity (95%) but limited specificity (75%) for detecting rectal temperatures >38°C.
Conclusions:
- Axillary temperature readings are consistently lower than rectal temperatures in infants.
- The wide limits of agreement indicate variability in axillary measurements.
- Axillary thermometry is suitable for fever screening, but critical readings necessitate confirmation with more accurate methods.
Abstract:
To better understand the role and reliability of axillary temperature measurements in clinical real life, axillary and rectal measurements in infants presenting in a private pediatric practice because of fever were compared. Prospectively, 169 infants (81 girls), median 9 (interquartile range 6-13) months of age, were examined at room temperature (20-24 °C). Two left and two right axillary, as well as two rectal measurements were taken with a digital thermometer and subsequently averaged. The median and interquartile range for axillary and rectal measurements were 36.9 (36.3-37.6) °C and 38.2 (37.4-38.9) °C, respectively (p < 0.0001). The limits of agreement in the Bland-Altman plots were 0.32 to 1.98 °C, with a mean bias of 1.15 °C. Axillary thermometers showed a good sensitivity for detecting rectal temperature > 38 °C (95%) but limited specificity (75%), with an area-under-the-curve of 0.95.Conclusions: Axillary readings are always lower than rectal ones, the limits of agreement are quite wide. Axillary readings can be used for screening but critical measurements should be confirmed by more reliable methods. What is Known • In infants and toddlers, temperature has been traditionally taken rectally. • Axillary measurements are better accepted and are recommended in current guidelines. What is New • Axillary temperature was always lower than rectal temperature. • The limits of agreement of axillary thermometers are wide. • Axillary thermometers have a good sensitivity but limited specificity and are therefore adequate for fever screening.
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