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 >38.0degreesC and >38.3degreesC with sensitivities of greater than or equal to90% and greater than or equal to95%, respectively, was determined for the TAPM. Results: The mean difference between the rectal minus TAPM was -0.19degreesC +/- 0.66degreesC, and minus the TACM home device, it was +0.11degreesC +/- 0.66degreesC. The sensitivities of TAPM temperature of greater than or equal to37.7degreesC to detect rectal fever greater than or equal to38.0degreesC and greater than or equal to38.3 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 38.0degreesC and greater than or equal to38.3degreesC, respectively. Conclusions: The TAPM thermometer cannot replace the rectal. However, TAPM temperature of <37.7degreesC can be safely used as a screen to exclude rectal fever greater than or equal to38.3degreesC 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.