Are Temporal Artery Temperatures Accurate Enough to Replace Rectal Temperature Measurement in Pediatric ED Patients?

ObjectiveThis study examined the accuracy of temporal artery and axillary temperatures compared with rectal temperatures in pediatric ED patients younger than 4 years.MethodsA method-comparison study design was used to examine the agreement between a temporal artery or axillary thermometer and a nondisposable, rectal electronic thermometer, which is the clinical reference standard for temperature measurement in children. Temperatures were taken with each device in a convenience sample of stable, pediatric ED patients who were younger than 4 years. Bias and precision were calculated to quantify the differences between the 2 devices, as well as the percentage of temporal artery and axillary temperatures that were >± 1.0°C and >±1.5°C higher or lower than the rectal temperature.ResultsA total of 52 pediatric ED patients were studied over a 10-month period. Bias and precision for the temporal artery and axillary devices were –0.46°C ± 0.50°C and –0.93°C ± 0.49°C, respectively. The percentage of temporal artery and axillary temperatures that were >± 1.0°C and/or >± 1.5°C above or below the clinical reference temperature were 15% and 6%, respectively, for the temporal artery thermometer and 39% and 14%, respectively, for the axillary thermometer.DiscussionBias and precision values for the temporal artery, but not the axillary temperature, were within the acceptable range set by experts to use as a noninvasive substitute for core body temperature measurements. If properly used by ED staff, temporal artery thermometers could be used to obtain temperature in pediatric patients younger than 4 years, thus avoiding physical and psychological discomfort for the child and parent associated with obtaining rectal thermometers.