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Comparison of Rectal, Axillary, and Forehead Temperatures

Frank Shann, MD, FRACP; Angela Mackenzie, MB,BS, FRACP
Arch Pediatr Adolesc Med. 1996;150(1):74-78. doi:10.1001/archpedi.1996.02170260078013.
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Objective:  To assess whether axillary and forehead temperatures accurately reflect the rectal temperature (the criterion standard).

Design:  Prospective study with calculation of paired axillary-rectal and forehead-rectal temperature differences and their SDs.

Setting:  Referral hospital.

Participants:  Convenience sample of 120 patients, with 20 patients in each of six age groups (ie, <1 month, 1 to 5 months, 6 to 11 months, 12 to 23 months, 2 to 14years, and adults).

Results:  In newborns, the rectal temperature was equal to the axillary temperature plus 0.2°C for each week of age up to 5 weeks; forehead strip thermometers gave inaccurate readings in this age group. In patients older than 1 month, the mean difference (SD) between the rectal and axillary temperatures was 1.04°C (0.45°C); thus, the axillary temperature was adjusted by adding 1°C, and no adjusted axillary temperature differed from the rectal temperature by more than 1°C. The mean difference (SD) between the forehead temperature that was measured by the best forehead liquid crystal strip thermometer (FeverScan) and the rectal temperature was 0.14°C (0.60°C); 10 forehead temperatures differed from the rectal temperature by more than 1°C.

Conclusions:  Previous studies that have suggested that axillary and forehead temperatures do not provide a reliable guide to the rectal temperature have all used inappropriate methods of analysis (correlation coefficients or sensitivity and specificity); previous studies that have based their conclusions on the correct method of analysis (paired differences and their SDs) have all found that the axillary temperature gives a good indication of the rectal temperature. The axillary temperature can be measured safely at any age, and the axillary temperature plus 1°C is a good guide to the rectal temperature in patients older than 1 month. Forehead strip thermometers are easy to use, but they do not estimate the rectal temperature as accurately as the axillary temperature does.(Arch Pediatr Adolesc Med. 1996;150:74-78)

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