Comparison of the temporal artery and rectal thermometry in children in the emergency department.

OBJECTIVE: Rectal thermometry, the criterion standard of temperature measurement in young children, has numerous disadvantages. This study examined the agreement between rectal versus a new temporal artery professional model (TAPM) thermometer and rectal versus a home device temporal artery consumer model (TACM) thermometer, investigated if the TAPM can safely screen for rectal fever, and determined if parents can detect rectal fever using the TACM. DESIGN, OUTCOME MEASURES, AND SUBJECTS: In this cross-sectional agreement emergency department study, 327 children <24 months of age had their temperature measured rectally and by the TAPM and TACM by a single nurse and using the TACM by the parents. Agreements were analyzed by the Bland Altman plots. Temperature cutoff to detect rectal fever > or =38.0 degrees C and > or =38.3 degrees C with sensitivities of > or =90% and > or =95%, respectively, was determined for the TAPM. RESULTS: The mean difference between the rectal minus TAPM was -0.19 degrees C +/- 0.66 degrees C, and minus the TACM home device, it was +0.11 degrees C +/- 0.66 degrees C. The sensitivities of TAPM temperature of > or =37.7 degrees C to detect rectal fever > or =38.0 degrees C and > or =38.3 degrees C were 90% (95% confidence interval: 0.83; 0.94) and 97% (95% confidence interval: 0.92; 0.99), respectively. The parents detected 67% and 73% of rectal fevers 38.0 degrees C and > or =38.3 degrees C, respectively. CONCLUSIONS: The TAPM thermometer cannot replace the rectal. However, TAPM temperature of <37.7 degrees C can be safely used as a screen to exclude rectal fever > or =38.3 degrees C in infants 3 to 24 months of age. The TACM home device has insufficient ability to detect rectal fever. A multicenter trial is needed to validate these results across multiple emergency departments and numerous observers.

Comparison of temporal artery, rectal and esophageal core temperatures in children: Results of a pilot study.

BACKGROUND: Rectal thermometry correlates with core temperature and represents the criterion standard of measuring temperatures in young children. However, it has numerous disadvantages, and thus, an alternative method of measuring temperature with similar agreement with the core temperature as rectal thermometry is desired. A new, noninvasive temporal artery (TA) thermometer synthesizes the skin surface and ambient temperatures to produce an arterial temperature. OBJECTIVE: To examine the agreement between the TA and esophageal core thermometers, and to compare it with that between rectal and esophageal temperatures. METHODS: In the present prospective, cross-sectional agreement study, intubated surgical outpatients younger than 18 years of age had temperatures measured with esophageal and rectal probes, and rectal electronic and TA thermometers. The agreement between esophageal versus rectal and TA thermometers was analyzed by intraclass correlation coefficients and by differences between esophageal versus TA and rectal temperatures with 95% CIs. The esophageal-rectal and esophageal-TA slopes were compared by Student's t test. RESULTS: In 80 enrolled children, the intraclass correlation coefficients for the esophageal probe versus rectal probe, rectal electronic thermometer and TA thermometer were 0.91, 0.95 and 0.88, respectively. The mean esophageal-rectal difference was 0.00+/-0.18 degrees C and esophageal-TA difference was 0.14+/-0.20 degrees C. Linear regression analysis of the relation between esophageal probe versus rectal probe, rectal thermometer and TA thermometer yielded slopes of 0.93, 0.94 and 0.89, respectively. The slopes were neither different from each other (P=0.70) nor from the value of 1. CONCLUSION: The TA and esophageal thermometers agree well, and the esophageal-TA and esophageal-rectal temperature agreements are not significantly different.