title: Emergency department rectal temperatures in over 10 years: A retrospective observational study.
abstract: BACKGROUND
  Fever in patients can provide an important clue to the etiology of a patient's symptoms. Non-invasive temperature sites (oral, axillary, temporal) may be insensitive due to a variety of factors. This has not been well studied in adult emergency department patients. To determine whether emergency department triage temperatures detected fever adequately when compared to a rectal temperature.
  
  
  METHODS
  A retrospective chart review was made of 27 130 adult patients in a high volume, urban emergency department over an eight-year period who received first a non-rectal triage temperature and then a subsequent rectal temperature.
  
  
  RESULTS
  The mean difference in temperatures between the initial temperature and the rectal temperature was 1.3 °F (P<0.001), with 25.9% of the patients having higher rectal temperatures ≥2 °F, and 5.0% having higher rectal temperatures ≥4 °F. The mean difference among the patients who received oral, axillary, and temporal temperatures was 1.2 °F (P<0.001), 1.8 °F (P<0.001), and 1.2 °F (P<0.001) respectively. About 18.1% of the patients were initially afebrile and found to be febrile by rectal temperature, with an average difference of 2.5 °F (P<0.001). These patients had a higher rate of admission (61.4%, P<0.005), and were more likely to be admitted to the hospital for a higher level of care, such as an intensive care unit, when compared with the full cohort (12.5% vs. 5.8%, P<0.005).
  
  
  CONCLUSIONS
  There are significant differences between rectal temperatures and non-invasive triage temperatures in this emergency department cohort. In almost one in five patients, fever was missed by triage temperature.
authors.affiliation: Department of Emergency Medicine, Kaiser Permanente, San Francisco, USA.
authors.forename: Graham A
authors.initials: GA
authors.lastname: Walker
authors.affiliation: Department of Emergency Medicine, University of California, Los Angeles, USA.
authors.forename: Daniel
authors.initials: D
authors.lastname: Runde
authors.affiliation: Department of Emergency Medicine, St. Luke's-Roosevelt Hospital Center, Columbia University College of Physicians and Surgeons, New York, USA.
authors.forename: Daniel M
authors.initials: DM
authors.lastname: Rolston
authors.affiliation: Department of Emergency Medicine, St. Luke's-Roosevelt Hospital Center, Columbia University College of Physicians and Surgeons, New York, USA.
authors.forename: Dan
authors.initials: D
authors.lastname: Wiener
authors.affiliation: Massachusetts General Hospital, Harvard Medical School, South Boston, MA 02127, USA.
authors.forename: Jarone
authors.initials: J
authors.lastname: Lee
keywords: Axillary temperatures; Emergency department; Oral temperatures; Rectal temperatures