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January 1996, Vol 150, No. 1 >
Article | January 1996

Comparison of Rectal, Axillary, and Forehead Temperatures FREE

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)

REFERENCES

1 +
Horwitz MA, Bennett JV.  Nursery outbreak of peritonitis with pneumoperitoneum probably caused by thermometer-induced rectal perforation . Am J Epidemiol . 1976;;104:632-644.
2 +
McAllister TA, Roud JA, Marshall A, Holland BM, Turner TL.  Outbreak of Salmonella eimsbuettel in newborn infants spread by rectal thermometers . Lancet . 1986;;1:1262-1264.
3 +
Barrus DH.  A comparison of rectal and axillary temperatures by electronic thermometer measurement in preschool children . Pediatr Nurs . 1983;;9:424-425.
4 +
Eoff MJF, Meier RS, Miller C.  Temperature measurements in infants . Nurs Res . 1974;;23:457-460.
5 +
Haddock B, Vincent P, Merrow D.  Axillary and rectal temperatures of full-term neonates: are they different? Neonatal Network . 1986;;5:36-40.
6 +
Moen JE, Chapman S, Sheehan A, Carter P.  Axillary versus rectal temperatures in preterm infants under radiant warmers . J Obstet Gynecol Neonatal Nurs . 1987;;16:348-352.
7 +
Torrance JT.  Temperature readings of premature infants . Nurs Res . 1968;;17: 312-320.
8 +
Schiffman RF.  Temperature monitoring in the neonate: a comparison of axillary and rectal temperatures . Nurs Res . 1982;;31:274-277.
9 +
Mayfield ST, Bhatia J, Nakamura KT, Rios GR, Bell EF.  Temperature measurement in term and preterm neonates . J Pediatr . 1984;;104:271-275.
10 +
Ilsley AL, Rutten AJ, Runciman WB.  An evaluation of body temperature measurement . Anaesth Intensive Care . 1983;;11:31-39.
11 +
Buntain WL, Pregler M, O'Brien PC, Lynn HB.  Axillary versus rectal temperature: a comparative study . J La State Med Soc . 1977;;129:5-8.
12 +
Ogren JM.  The inaccuracy of axillary temperatures measured with an electronic thermometer . AJDC . 1990;;144:109-111.
13 +
Kresch MJ.  Axillary temperature as a screening test for fever in children . J Pediatr . 1984;;104:596-599.
14 +
Martyn KK, Urbano MT, Hayes JS, von Windeguth B, Sherrin T.  Comparison of axillary, rectal and skin-based temperature assessment in preschoolers . Nurse Pract . 1988;;13:31-36.
15 +
Scholefield JH, Gerber MA, Dwyer P.  Liquid crystal forehead temperature strips . AJDC . 1982;;136:198-201.
16 +
Masters JE.  Comparison of axillary, oral, and forehead temperature . Arch Dis Child . 1980;;55:896-898.
17 +
David CB.  Liquid crystal forehead temperature strips . AJDC . 1983;;137:87.
18 +
Lau JTK, Ong GB.  Broken and retained rectal thermometers in infants and young children . Aust Paediatr J . 1981;;17:93-94.
19 +
Nichols GA, Ruskin MM, Glor BAK, Kelly WH.  Oral, axillary, and rectal temperature determinations and relationships . Nurs Res . 1966;;15:307-310.
20 +
Reisinger KS, Kao J, Grant DM.  Inaccuracy of the Clinitemp skin thermometer . Pediatrics . 1979;;64:4-6.
21 +
Lewit EM, Marshall CL, Salzer JE.  An evaluation of a plastic strip thermometer . JAMA . 1982;;247:321-325.
22 +
Vaughan MS, Cork RC, Vaughan RW.  Inaccuracy of liquid crystal thermometry to identify core temperature trends in postoperative adults . Anesth Analg . 1982;;61:284-287.
23 +
Shann F, Mackenzie A.  Axillary or rectal temperature in children? Lancet. 1981;; 2:310.
24 +
Bland JM, Altman DG.  Statistical methods for assessing agreement between two methods of clinical measurement . Lancet . 1986;;1:307-310.
25 +
Royston JP.  An extension of Shapiro and Wilk's W test for normality to large samples . Appl Stat . 1982;;31:115-124.
26 +
Mills JN.  Development of circadian rhythms in infancy . In: Davis JA, Dobbing J, eds. Scientific Foundations of Paediatrics . London, England: Heinemann Medical Books Ltd; 1974;:761.
27 +
Bayley N, Stolz HR.  Maturational changes in rectal temperatures of 61 infants from 1 to 36 months . Child Dev . 1937;;8:195-206.
28 +
Imrie MM, Hall GM.  Body temperature and anaesthesia . Br J Anaesth . 1990;; 64:346-354.
29 +
Eichna LW, Berger AR, Rader B, Becker WH.  Comparison of intracardiac and intravascular temperatures with rectal temperatures in man . J Clin Invest . 1951;; 30:353-359.
30 +
Ibsen B.  Treatment of shock with vasodilators measuring skin temperature on the big toe . Chest . 1967;;52:425-429.
31 +
 Hazards of temperature taking . BMJ . 1970;;3:4-5.
32 +
Karlberg P.  The significance of depth of insertion of the thermometer for recording rectal temperatures . Acta Paediatr Scand . 1949;;38:359-366.

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References

1 +
Horwitz MA, Bennett JV.  Nursery outbreak of peritonitis with pneumoperitoneum probably caused by thermometer-induced rectal perforation . Am J Epidemiol . 1976;;104:632-644.
2 +
McAllister TA, Roud JA, Marshall A, Holland BM, Turner TL.  Outbreak of Salmonella eimsbuettel in newborn infants spread by rectal thermometers . Lancet . 1986;;1:1262-1264.
3 +
Barrus DH.  A comparison of rectal and axillary temperatures by electronic thermometer measurement in preschool children . Pediatr Nurs . 1983;;9:424-425.
4 +
Eoff MJF, Meier RS, Miller C.  Temperature measurements in infants . Nurs Res . 1974;;23:457-460.
5 +
Haddock B, Vincent P, Merrow D.  Axillary and rectal temperatures of full-term neonates: are they different? Neonatal Network . 1986;;5:36-40.
6 +
Moen JE, Chapman S, Sheehan A, Carter P.  Axillary versus rectal temperatures in preterm infants under radiant warmers . J Obstet Gynecol Neonatal Nurs . 1987;;16:348-352.
7 +
Torrance JT.  Temperature readings of premature infants . Nurs Res . 1968;;17: 312-320.
8 +
Schiffman RF.  Temperature monitoring in the neonate: a comparison of axillary and rectal temperatures . Nurs Res . 1982;;31:274-277.
9 +
Mayfield ST, Bhatia J, Nakamura KT, Rios GR, Bell EF.  Temperature measurement in term and preterm neonates . J Pediatr . 1984;;104:271-275.
10 +
Ilsley AL, Rutten AJ, Runciman WB.  An evaluation of body temperature measurement . Anaesth Intensive Care . 1983;;11:31-39.
11 +
Buntain WL, Pregler M, O'Brien PC, Lynn HB.  Axillary versus rectal temperature: a comparative study . J La State Med Soc . 1977;;129:5-8.
12 +
Ogren JM.  The inaccuracy of axillary temperatures measured with an electronic thermometer . AJDC . 1990;;144:109-111.
13 +
Kresch MJ.  Axillary temperature as a screening test for fever in children . J Pediatr . 1984;;104:596-599.
14 +
Martyn KK, Urbano MT, Hayes JS, von Windeguth B, Sherrin T.  Comparison of axillary, rectal and skin-based temperature assessment in preschoolers . Nurse Pract . 1988;;13:31-36.
15 +
Scholefield JH, Gerber MA, Dwyer P.  Liquid crystal forehead temperature strips . AJDC . 1982;;136:198-201.
16 +
Masters JE.  Comparison of axillary, oral, and forehead temperature . Arch Dis Child . 1980;;55:896-898.
17 +
David CB.  Liquid crystal forehead temperature strips . AJDC . 1983;;137:87.
18 +
Lau JTK, Ong GB.  Broken and retained rectal thermometers in infants and young children . Aust Paediatr J . 1981;;17:93-94.
19 +
Nichols GA, Ruskin MM, Glor BAK, Kelly WH.  Oral, axillary, and rectal temperature determinations and relationships . Nurs Res . 1966;;15:307-310.
20 +
Reisinger KS, Kao J, Grant DM.  Inaccuracy of the Clinitemp skin thermometer . Pediatrics . 1979;;64:4-6.
21 +
Lewit EM, Marshall CL, Salzer JE.  An evaluation of a plastic strip thermometer . JAMA . 1982;;247:321-325.
22 +
Vaughan MS, Cork RC, Vaughan RW.  Inaccuracy of liquid crystal thermometry to identify core temperature trends in postoperative adults . Anesth Analg . 1982;;61:284-287.
23 +
Shann F, Mackenzie A.  Axillary or rectal temperature in children? Lancet. 1981;; 2:310.
24 +
Bland JM, Altman DG.  Statistical methods for assessing agreement between two methods of clinical measurement . Lancet . 1986;;1:307-310.
25 +
Royston JP.  An extension of Shapiro and Wilk's W test for normality to large samples . Appl Stat . 1982;;31:115-124.
26 +
Mills JN.  Development of circadian rhythms in infancy . In: Davis JA, Dobbing J, eds. Scientific Foundations of Paediatrics . London, England: Heinemann Medical Books Ltd; 1974;:761.
27 +
Bayley N, Stolz HR.  Maturational changes in rectal temperatures of 61 infants from 1 to 36 months . Child Dev . 1937;;8:195-206.
28 +
Imrie MM, Hall GM.  Body temperature and anaesthesia . Br J Anaesth . 1990;; 64:346-354.
29 +
Eichna LW, Berger AR, Rader B, Becker WH.  Comparison of intracardiac and intravascular temperatures with rectal temperatures in man . J Clin Invest . 1951;; 30:353-359.
30 +
Ibsen B.  Treatment of shock with vasodilators measuring skin temperature on the big toe . Chest . 1967;;52:425-429.
31 +
 Hazards of temperature taking . BMJ . 1970;;3:4-5.
32 +
Karlberg P.  The significance of depth of insertion of the thermometer for recording rectal temperatures . Acta Paediatr Scand . 1949;;38:359-366.

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