Pediatric Temperature

my experience is anecdotal, but i have gotten much higher/probably more accurate readings with a rectal temp on both kids and septic adults. my experience with temporal thermometers hasn't always been great. i feel like we know that rectal temperatures are generally accurate and correlate with core temps... if you need an accurate temp in a critical situation, are you willing to chance it? i'll continue to take rectal temps as needed... the literature i've found at a glance seems to support this.

here's a couple conclusions from abstracts i found on medline/cinahl just now. sorry the citations aren't beautiful, copying and pasting doesn't work super great but you can find the studies/abstracts if need be.

barnett et al. (2011). oral and tympanic membrane temperatures are inaccurate to identify fever in emergency department adults. west j emerg med 12 (4), p. 505-11

conclusion: [color=#333333]the oral and tympanic temperature readings are not equivalent to rectal[color=#333333] thermometry readings.[color=#333333] oral thermometry frequently underestimates the temperature relative to rectal[color=#333333] readings, and tm values can either under- or overestimate the rectal [color=#333333]temperature.[color=#333333] the clinician needs to be aware of the varying relationship between oral, tm, and rectal[color=#333333] temperatures[color=#333333] when interpreting readings.

hebbar k ; fortenberry jd ; rogers k ; merritt r ; easley k. (2005). comparison of temporal artery thermometer to standard temperature measurements in pediatric intensive care unit patients. pediatr crit care med 6(5), p. 557-561 conclusions: temporal artery and axillary temperature measurements showed variability torectal temperatures but had marked variability in febrile children. neither was sufficiently accurate to recommend replacingrectal or other invasive methods. as temporal artery and axillary provide similar accuracy, temporal artery thermometers may serve as a suitable alternative for patients in whom invasive thermometry is contraindicated.

wilshaw r ; beckstrand r ; waid d ; schaalje gb. (1999). a comparison of the use of tympanic, axillary, and rectal thermometers in infants.. j pediatr nurs, 1999 14(2), p. 88-93

this study examined the relationship between three instruments used in measuring tympanic, axillary, and rectal temperatures in infants less than 1 year of age. temperatures were measured by oto-temp pedi q tympanic thermometers, becton dickinson axillary thermometer, and rectal thermometers. a convenience sample of 5 infants less than 90 day and 54 greater than 90 days with fever, as well as 34 infants less than 90 days and 27 infants greater than 90 days without fever were studied. correlations of infants less than 90 days and greater 90 days of age, as well as differences between infant temperature with and without fevers as variables, were examined. results indicated a strong statistical relationship between oto-temp pedi q, becton dickinson axillarytemperatures, and rectal temperatures, but not strong enough to base critical clinical decisions. age and presence or absence of fever significantly affected the relationships between thermometers.

i also found an article titled "technical note: comparison of rectal and lady partsl temperatures in lactating dairy cows."

must have checked an extra box on ebsco... oops.

We prefer a core temperature measurement (oral or rectal) unless contraindicated due to oral surgery or immunosuppression. However, I don't like doing rectal temps frequently on kids (we do temps q 2-4 hours in the PICU). So I'll usually do a rectal temp first and then an axillary right after and compare. If there is a serious difference then I'll continue to use rectal, but if they correlate then I'll do the axillary unless I have a reason to think it's not accurate (such as the child is tachycardic, feels hot to the touch, irritable and the axillary temp is normal).

Rectal is the gold standard but I use it rarely. I prefer oral or axillary to tympanic, especially since I am often taking care of post-op craniotomies. I use rectal if the patient's temperature seems really out of range... I have had readings of 33 degrees Celcius with a tympanic thermometer before (I hate tympanics) as well as 40 degrees.

I love my tympanic! Easy, non-invasive, and I've tested it against a rectal temp on the same patient at the same time and it was within .1 degree. The only time I've ever had wacky readings and it's obviously off is when the battery needs changed. In an emergency I'd probably go with a rectal, but overall, I've had no issues with my temporal one and I've had it for over 5 years now. Honestly I've been doing peds for almost 14 years now and the last thing I want to do to a small child or infant who's sick and sleeping is start throwing them around a bed to ram a foreign object up their rears. Most parents I've dealt with are happy with is as well.