Temperature measured at the axilla compared with rectum in children and young people: systematic review

• Published in: BMJ Vol. 320; no. 7243; pp. 1174 - 1178
• Main Authors: Craig, Jean V, Lancaster, Gillian A, Williamson, Paula R, Smyth, Rosalind L
• Format: Journal Article
• Language: English
• Published: London British Medical Journal Publishing Group 29-04-2000; British Medical Association; BMJ Publishing Group LTD; BMJ Publishing Group; British Medical Journal
• Edition: International edition
• Subjects: Adolescent; Axilla; Axilla - physiology; Biological and medical sciences; Body Temperature; Child; Child, Preschool; Children; Children & youth; Data Collection; Health care; Humans; Infant; Infant, Newborn; Infants; Investigative techniques, diagnostic techniques (general aspects); Medical sciences; Miscellaneous. Technology; Newborns; Pathology. Cytology. Biochemistry. Spectrometry. Miscellaneous investigative techniques; Rectum; Rectum - physiology; Standard deviation; Temperature; Temperature gradients; Temperature measurement; Temperature probes; Thermometers; Human; Temperature measurement; Adolescent; Rectum; Axilla; Variations; Technique; Child; Comparative study; Fever
• ISSN: 0959-8138; 0959-8146; 1468-5833; 1756-1833
• DOI: 10.1136/bmj.320.7243.1174

Abstract Objective: To evaluate the agreement between temperature measured at the axilla and rectum in children and young people Design: A systematic review of studies comparing temperature measured at the axilla (test site) with temperature measured at the rectum (reference site) using the same type of measuring device at both sites in each patient. Devices were mercury or electronic thermometers or indwelling thermocouple probes. Studies reviewed: 40 studies including 5528 children and young people from birth to 18 years. Data extraction: Difference in temperature readings at the axilla and rectum. Results: 20 studies (n=3201 (58%) participants) had sufficient data to be included in a meta-analysis. There was significant residual heterogeneity in both mean differences and sample standard deviations within the groups using different devices and within age groups. The pooled (random effects) mean temperature difference (rectal minus axillary temperature) for mercury thermometers was 0.25°C (95% limits of agreement −0.15°C to 0.65°C) and for electronic thermometers was 0.85°C (−0.19°C to 1.90°C). The pooled (random effects) mean temperature difference (rectal minus axillary temperature) for neonates was 0.17°C (−0.15°C to 0.50°C) and for older children and young people was 0.92°C (−0.15°C to 1.98°C). Conclusions: The difference between temperature readings at the axilla and rectum using either mercury or electronic thermometers showed wide variation across studies. This has implications for clinical situations where temperature needs to be measured with precision.