A comparison of axillary and tympanic membrane to rectal temperatures in children
Abstract: Core body
temperature measurement is not commonly done in pediatric populations because
it is invasive and difficult to perform. Therefore, axillary and tympanic
membrane temperature measurements are preferable, but their accuracy is still
debatable.
Objective To compare the accuracy of axillary and tympanic temperatures
to rectal temperature in children with fever, and to measure the cut-off point
for fever based on each temperature measurement method.
Methods A diagnostic study was conducted among feverish children aged 6
months to 5 years who were consecutively selected from the Pediatric Outpatient
Clinic, Pediatric Emergency Unit, and the inpatient ward in the Department of
Child Health, Cipto Mangunkusumo Hospital (CMH), from December 2014 to January
2015. Subjects underwent three measurements within a two minute span, namely,
the axillary, tympanic membrane, and rectal temperature measurements. The
values obtained from the examination were analyzed with appropriate statistical
tests.
Results The cut-off for fever on axilla was 37.4oC and on tympanic
membrane was 37.4oC, with sensitivity
96% (95%CI 0.88 to 0.98) and 93% (95%CI 0.84 to 0.97), respectively;
specificity 50% (95%CI 0.47 to 0.84) and 50% (95%CI 0.31 to 0.69),
respectively; positive predictive value/PPV 90% (95%CI 0.81 to 0.95) and 85%
(95%CI 0.75 to 0.91), respectively; and negative predictive value/NPV 83%
(95%CI 0.61 to 0.94) and 69% (95%CI 0.44 to 0.86), respectively. The optimal
cut-off of tympanic membrane and axilla temperature was 37.8oC (AUC 0.903 and
0.903, respectively).
Conclusion Axillary temperature measurement is as good as tympanic
membrane temperature measurement and can be used in daily clinical practice or
at home. By increasing the optimum fever cut-off point for axillary and
tympanic membrane temperature to 37.8oC, we find sensitivity 81% and 88%,
specificity 86% and 73%, PPV 95% and 91%, and NPV 95% and 91%, respectively.
Keywords: children; axillary
temperature; tympanic temperature; rectal temperature; feve
Author: Tania Paramita, Mulya
Rahma Karyanti, Soedjatmiko, Aryono Hendarto, Dadi Suyoko, Abdul Latief
Journal Code: jpkedokterangg170073
