title: Are temporal artery temperatures accurate enough to replace rectal temperature measurement in pediatric ED patients?
abstract: OBJECTIVE
  This study examined the accuracy of temporal artery and axillary temperatures compared with rectal temperatures in pediatric ED patients younger than 4 years.
  
  
  METHODS
  A 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.
  
  
  RESULTS
  A 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.
  
  
  CONCLUSIONS
  Bias 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.
authors.affiliation: Portland, OR. Electronic address: marcia.reynolds@providence.org.
authors.forename: Marcia
authors.initials: M
authors.lastname: Reynolds
authors.affiliation: Portland, OR.
authors.forename: Laura
authors.initials: L
authors.lastname: Bonham
authors.affiliation: Portland, OR.
authors.forename: Margaret
authors.initials: M
authors.lastname: Gueck
authors.affiliation: Portland, OR.
authors.forename: Katherine
authors.initials: K
authors.lastname: Hammond
authors.affiliation: Portland, OR.
authors.forename: Jessica
authors.initials: J
authors.lastname: Lowery
authors.affiliation: Portland, OR.
authors.forename: Cheryll
authors.initials: C
authors.lastname: Redel
authors.affiliation: Portland, OR.
authors.forename: Christine
authors.initials: C
authors.lastname: Rodriguez
authors.affiliation: Portland, OR.
authors.forename: Suzanne
authors.initials: S
authors.lastname: Smith
authors.affiliation: Portland, OR.
authors.forename: Anne
authors.initials: A
authors.lastname: Stanton
authors.affiliation: Portland, OR.
authors.forename: Stephanie
authors.initials: S
authors.lastname: Sukosd
authors.affiliation: Portland, OR.
authors.forename: Marla
authors.initials: M
authors.lastname: Craft
mesh_terms: D001831:Body Temperature / Q000502:physiology*; D002675:Child, Preschool; D016529:Emergency Nursing / Q000379:methods; D004636:Emergency Service, Hospital; D005260:Female; D005334:Fever / Q000175:diagnosis*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D010371:Pediatric Nursing / Q000379:methods; D012007:Rectum; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D013699:Temporal Arteries; D013821:Thermometers / Q000706:statistics & numerical data*
keywords: Axillary temperature; Bias; Forehead temperature; Medical device; Precision