Abstract
BackgroundMeasuring rectal temperature in children is the gold standard, but ear or forehead measures are less traumatic and faster. The quality of non-invasive devices has improved but concerns remain whether they are reliable enough to substitute rectal thermometers.The aim was to evaluate in a real-life children population whether the forehead or ear temperature measurements could be used in screening to detect fever and if the agreement with the rectal temperature for different age groups is acceptable for clinical use.MethodsCross-sectional clinical study comparing temporal and tympanic temperatures to rectal temperature in 0–18-year-old children. The ear thermometer was a Pro 4000 Thermoscan, the temporal Exergen TAT. Rectal temperature ≥ 38.0 °C was defined as fever.ResultsAmong 995 children, 39% had a fever. The ear thermometer had a significantly greater ability to detect fever than the temporal thermometer (AUC 0.972; 95% CI: 0.963–0.981 versus AUC 0.931; 95% CI: 0.915–0.947, p < 0.0001). Both devices had the lowest sensitivity in the youngest and oldest children, and only the ear thermometer reached a sensitivity above 90% in the 0.5–5-year age group. The Bland-Altman analysis showed that the 95% limits of agreement for the temporal thermometer was between − 1.2 to + 1.5 °C and for the ear thermometer between − 0.97 to + 1.07 °C.ConclusionsBased on a large sample of children, the temporal measurement of temperature is not currently recommendable, but with the technology used in this study the ear measurement proved useful for screening purposes, especially among children aged 6 months to 5 years. For the exact measurement of temperature, the rectal method is still recommended.
Highlights
Measuring rectal temperature in children is the gold standard, but ear or forehead measures are less traumatic and faster
A range of studies support this suggestion [4–7]. Since these studies have limitations in size or methodology, concerns have been raised as to whether the new devices are reliable enough to substitute for the Mogensen et al BMC Pediatrics (2018) 18:15 rectal thermometer and if this reliability is consistent within different age groups [8]
The aim of the present study was, in a real-life population of children, acutely referred to a pediatric department; firstly, to evaluate, based on current technology, whether forehead or ear temperature measurements could be used as a screening tool to detect fever; and, secondly, to evaluate how well these measurements agrees with the rectal temperature within different age groups of children
Summary
Measuring rectal temperature in children is the gold standard, but ear or forehead measures are less traumatic and faster. The quality of these devices for rapid, noninvasive temperature measurements has improved in recent years and suggestions have been made to replace rectal thermometers with these alternatives for children or to use the devices as screening instruments for fever [1, 3]. A range of studies support this suggestion [4–7] Since these studies have limitations in size or methodology, concerns have been raised as to whether the new devices are reliable enough to substitute for the Mogensen et al BMC Pediatrics (2018) 18:15 rectal thermometer and if this reliability is consistent within different age groups [8]
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