Are temporal artery temperatures accurate enough to replace rectal temperature measurement in pediatric ED patients?

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. Discussion: 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.