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Rectal-axillary temperature difference in febrile and afebrile infants and children
D Anagnostakis1, N Matsaniotis, S Grafakos
1First Department of Pediatrics, Athens University, Aghia Sophia Children's Hospital, Greece.
Insights
Measuring rectal-axillary temperature difference (R-A) in children reveals significant variability. Axillary temperatures can appear normal even when rectal temperatures indicate fever onset.
Area of Science:
- Pediatrics
- Clinical Thermometry
Background:
- Accurate temperature measurement is crucial for diagnosing fever in children.
- The rectal-axillary temperature difference (R-A) is often used to estimate core body temperature.
Purpose of the Study:
- To investigate the variability of the rectal-axillary temperature difference (R-A) in children aged 0-5 years.
- To determine if a standard conversion factor exists between rectal and axillary temperatures.
Main Methods:
- Measured R-A difference in 1,149 children (birth to 5 years) on 1,519 occasions.
- Included both febrile (rectal temp ≥ 38°C) and afebrile children.
- Analyzed R-A difference in relation to sex, age, and fever duration.
Main Results:
- A wide range of R-A differences was observed in both febrile and afebrile children.
- R-A difference was not significantly associated with sex or age.
- In febrile children, R-A was significantly greater at fever onset (1.04°C) compared to later (0.53°C).
Conclusions:
- It is impossible to establish a standard conversion factor between axillary and rectal temperatures.
- Axillary temperature may underestimate rectal temperature, especially at fever onset, potentially masking elevated core temperatures.
Abstract:
The rectal-axillary temperature difference (R-A) was measured in the morning, at midday, and in the afternoon on 1,519 occasions in 1,149 children from birth to 5 years old. Of these, 302 children were febrile (rectal temperature > or = 38 degrees C) and 847 were afebrile. A wide range in R-A was found for each individual in both groups. The magnitude of this difference was not associated with sex or age. In febrile children, the R-A was significantly greater (P < .0001) at the apparent onset of fever (1.04 +/- 0.25 degrees C) than later, when fever had been present for at least two hours (0.53 +/- 0.22 degrees C). These findings indicate that it is impossible to find a standard number by which to convert axillary to rectal temperature or vice versa. Furthermore axillary temperature may be relatively low or even "normal" despite an elevated rectal temperature at the onset of fever.