title: Axillary, Oral and Rectal Routes of Temperature Measurement During Treatment of Acute Kawasaki Disease.
abstract: BACKGROUND
  Important therapeutic decisions are made based on the presence or absence of fever in patients with Kawasaki disease (KD), yet no standard method or threshold exists for temperature measurement during the diagnosis and treatment of these patients. We sought to compare surface and internal (rectal or oral) routes of temperature measurement for the detection of fever as a marker of treatment resistance.
  
  
  METHODS
  From a randomized, placebo-controlled trial of infliximab as an adjunct to primary intravenous immunoglobulin treatment for acute KD, we collected concurrent (within 5 minutes) axillary and internal temperature measurements and performed receiver-operating characteristic and Bland-Altman analyses. We also determined the ability of surface temperatures to detect treatment resistance defined by internal temperature measurements.
  
  
  RESULTS
  Among 452 oral-axillary and 439 rectal-axillary pairs from 159 patients, mean axillary temperatures were 0.25 and 0.43 °C lower than oral and rectal temperatures and had high receiver-operating characteristic areas under curves. However, axillary temperatures ≥ 38.0 °C had limited sensitivity to detect fever defined by internal temperatures. Axillary thresholds of 37.5 and 37.2 °C provided maximal sensitivity and specificity to detect oral and rectal temperatures ≥ 38.0 °C, respectively.
  
  
  CONCLUSIONS
  Axillary temperatures are an insensitive metric for fevers defining treatment resistance. Clinical trials should adopt temperature measurement by the oral or rectal routes for adjudication of treatment resistance in KD.
authors.affiliation: From the *Department of Pediatrics, University of California San Diego School of Medicine, La Jolla, California; †Rady Children's Hospital San Diego, San Diego, California; ‡Department of Family and Preventive Medicine, University of California San Diego School of Medicine, La Jolla, California; and §Department of Pediatrics, The Ohio State University and Nationwide Children's Hospital, Columbus, Ohio.
authors.forename: John T
authors.initials: JT
authors.lastname: Kanegaye
authors.forename: Jefferson M
authors.initials: JM
authors.lastname: Jones
authors.forename: Jane C
authors.initials: JC
authors.lastname: Burns
authors.forename: Sonia
authors.initials: S
authors.lastname: Jain
authors.forename: Xiaoying
authors.initials: X
authors.lastname: Sun
authors.forename: Susan
authors.initials: S
authors.lastname: Jimenez-Fernandez
authors.forename: Erika
authors.initials: E
authors.lastname: Berry
authors.forename: Joan M
authors.initials: JM
authors.lastname: Pancheri
authors.forename: Preeti
authors.initials: P
authors.lastname: Jaggi
authors.forename: Octavio
authors.initials: O
authors.lastname: Ramilo
authors.forename: Adriana H
authors.initials: AH
authors.lastname: Tremoulet
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D001365:Axilla; D001831:Body Temperature; D002648:Child; D002675:Child, Preschool; D017326:Clinical Trials, Phase III as Topic; D005260:Female; D006801:Humans; D016756:Immunoglobulins, Intravenous / Q000627:therapeutic use; D007223:Infant; D000069285:Infliximab / Q000627:therapeutic use; D008297:Male; D009055:Mouth; D009080:Mucocutaneous Lymph Node Syndrome / Q000175:diagnosis* / Q000628:therapy; D012372:ROC Curve; D016032:Randomized Controlled Trials as Topic; D012007:Rectum; D015203:Reproducibility of Results; D016896:Treatment Outcome
chemical_list: D016756:Immunoglobulins, Intravenous; D000069285:Infliximab