title: Comparison of the temporal artery and rectal thermometry in children in the emergency department.
abstract: 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.
authors.affiliation: Division of Emergency Medicine, The Hospital for Sick Children, Toronto, ON, Canada. suzanne.schuh@sickkids.on.ca
authors.forename: Suzanne
authors.initials: S
authors.lastname: Schuh
authors.forename: Luba
authors.initials: L
authors.lastname: Komar
authors.forename: Derek
authors.initials: D
authors.lastname: Stephens
authors.forename: Lily
authors.initials: L
authors.lastname: Chu
authors.forename: Stanley
authors.initials: S
authors.lastname: Read
authors.forename: Upton
authors.initials: U
authors.lastname: Allen
mesh_terms: D002675:Child, Preschool; D003430:Cross-Sectional Studies; D004636:Emergency Service, Hospital; D004867:Equipment Design; D005334:Fever / Q000175:diagnosis*; D006801:Humans; D007223:Infant; D010808:Physical Examination / Q000379:methods; D011446:Prospective Studies; D012007:Rectum; D015203:Reproducibility of Results; D013699:Temporal Arteries; D013821:Thermometers