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 Table of Contents  
ORIGINAL ARTICLE
Year : 2016  |  Volume : 19  |  Issue : 2  |  Page : 149-151

Can axillary temperature reliably screen for fever in under - five children?


1 Department of Paediatrics, Imo State University Teaching Hospital, Owerri, Imo State, Nigeria
2 Department of Paediatrics, Federal Medical Centre, Owerri, Imo State, Nigeria

Date of Web Publication5-Jul-2016

Correspondence Address:
Kelechi Kenneth Odinaka
Department of Paediatrics, Imo State University Teaching Hospital, Imo State
Nigeria
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DOI: 10.4103/1119-0388.185444

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  Abstract 

Background: In most developing countries, the body temperature of children is routinely measured through the axilla because it is convenient. However, concerns have been raised concerning the reliability of axillary temperature in screening for fever especially in under five children. Objective: This study was carried out to determine the reliability of axillary temperature in screening for fever in under five children. Materials and Methods: This cross-sectional study was carried out at the Paediatric Department of Federal Medical Centre, Owerri, Imo State. Eligible children were consecutively recruited. Rectal and axillary temperatures were taken simultaneously in each eligible child with a mercury-in-glass thermometer. Statistical analysis was done using SPSS version 20. Results: A total of 156 children were recruited and the children were aged 1 day to 59 months. There were 81 males and 75 females. There was a positive correlation between rectal and axillary temperature. Using the rectal temperature as gold standard, the sensitivity and specificity of axillary temperature was 88.6% and 89.6% respectively. Conclusion: The high sensitivity and strong positive correlation between axillary and rectal temperatures show that the axillary temperature can reliably screen for fever.

Keywords: Axillary temperature, fever, rectal temperature


How to cite this article:
Odinaka KK, Nwolisa EC, Alfreda IC, Amamilo IO. Can axillary temperature reliably screen for fever in under - five children?. Trop J Med Res 2016;19:149-51

How to cite this URL:
Odinaka KK, Nwolisa EC, Alfreda IC, Amamilo IO. Can axillary temperature reliably screen for fever in under - five children?. Trop J Med Res [serial online] 2016 [cited 2019 Oct 17];19:149-51. Available from: http://www.tjmrjournal.org/text.asp?2016/19/2/149/185444


  Introduction Top


Body temperature is routinely measured in Paediatric clinics because it plays an integral role in the care of sick children. Many decisions concerning diagnostic investigations and treatment of children are based on the results of temperature measurement alone. [1],[2] The ideal site for temperature measurement is the hypothalamus because it reflects the "core temperature." However, since the hypothalamus is inaccessible, the rectum has been considered by most Paediatricians as the "gold standard" for temperature measurement in under - five children. [1],[3] Despite this consideration, rectal thermometry its drawbacks such a rectal perforation in neonates and interference with the privacy of the patient. In addition, most parents are not comfortable with the procedure while most children resent it. [1],[3]

The presence of fever in a child is a major cause of undue worry and fear for most parents and caregivers. Therefore, an accurate measurement of body temperature is of utmost importance in allaying this fear. In most Paediatric clinics in Nigeria, body temperature is measured through the axilla because it is convenient. Controversies over the reliability of axillary thermometry in screening for fever have been variously reported. While a study found it reliable in screening for fever, [4] others found it inaccurate in screening for fever. [5],[6],[7] The reliability of axillary thermometry in screening for fever remains uncertain. This study was carried out to determine the reliability of axillary thermometry in screening for fever in under - five children by comparing with the gold standard.


  Materials and Methods Top


This cross-sectional study was carried out at the Paediatric Department of Federal Medical Centre, Owerri, Imo State, Nigeria. Children under 5 years of age who presented for care at the children outpatient clinic of the hospital were enrolled into the study. Informed consent was obtained from each caregiver. Children who were adjudged to be critically ill or whose mothers declined consent were excluded from the study. Ethical approval was obtained from the Hospital Research and Ethics Committee before the commencement of the study.

Eligible children had their body temperature measured simultaneously from the axilla and rectum using standard mercury in glass axillary and rectal thermometers. The rectal mercury-in-glass thermometer was first lubricated and inserted into a depth of 3 cm inside the anus and left for 3 minutes before removal for reading, whereas the axillary mercury-in-glass thermometer was inserted with the tip at the apex of the axilla and the arm held firmly at the side by the mother/caregiver for 5 minutes before removal for reading. The thermometers were standardized before use by immersion in a warm water bath and ensuring that all readings were the same before use each day.

The data obtained were analyzed using IBM SPSS Statistics for Windows, Version 20.0. Armonk, NY: IBM Corp. Rectal temperature was used as a gold standard to test the accuracy of the axillary thermometer. The mean temperature difference between the two thermometry methods was tested using the paired t-test. P < 0.05 was considered significant. The correlation between rectal and axillary temperature was tested using the Pearson's correlation coefficient at 99% confidence interval. The sensitivity, specificity, positive, and negative predictive values were calculated at rectal temperature cut-off of 38°C.


  Results Top


A total of 156 temperature pairs were measures. The children aged from 1 day to 59 months with a mean age of 10.8 months. The rectal temperatures ranged from 35.7°C to 40.5°C with a mean rectal temperature of 38.1°C ± 0.9°C while the axillary temperatures ranged from 35.8°C to 39.9°C with a mean temperature of 37.5°C ± 0.9°C. The recto-axillary temperature difference ranged from 0.3°C to 2.8°C with a mean recto-axillary temperature difference of 0.6 ± 0.5°C. [Table 1] shows the distribution of the temperatures by age group. The mean recto-axillary temperature difference was significant among all the age groups. Pearson's correlation showed that there was a significant correlation between rectal and axillary temperatures at 0.01 level, r = 0.768 as shown in [Figure 1].
Figure 1: Scatter plot showing the relationship between axillary and rectal temperatures

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Table 1: Comparison of the mean rectal and axillary temperatures in the children studied


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With fever defined as the rectal temperature of 38.0°C or axillary temperature of 37.5°C, sensitivity of the axillary temperature to predict fever using the rectal as gold standard is 88.6% while specificity is 89.6%. The positive predictive value is 89.7% while the negative predictive value is 88.5% as depicted in [Table 2].
Table 2: A 2×2 table comparing rectal and axillary temperatures


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  Discussion Top


This study observed that the mean axillary readings differed significantly from the mean rectal temperature readings across all age groups. Other studies have also shown that axillary temperature is lower than rectal temperature. [8],[9],[10] This may explain the use of a lower cut-off for defining fever when using axilla for recording temperature. Traditionally, it is believed that rectal temperature can be estimated by adding 1°C to the temperature measured at the axilla, but the wide range in the mean differences observed in this study suggests that this is not the case. This finding is consistent with the study by Edelu et al., [9] who concluded that a particular value cannot be added to axillary temperature value to estimate the rectal temperature. Thus, axillary temperatures should not be used as a proxy for rectal temperature by adding a correction factor.

It was observed that there was a good positive correlation between axillary and rectal temperatures. Other authors have also reported similar findings. [8],[9],[10] This shows that there is a good relationship between axillary and rectal temperatures. Findings from this study shows that axillary temperatures can reliably screen for elevated rectal temperature in under five children as shown by a high sensitivity of 88.6%. This is similar to the findings of Jones et al., [4] who documented a sensitivity of 98%. However, it differed from the observation of Ogren [6] who documented a sensitivity of 46%. Ogren [6] concluded that axillary temperatures are not sensitive enough to screen for fever and should be abandoned in the outpatient setting. Other studies have also shown that axillary temperature is inaccurate in screening for fever in children. [5],[7] The reason for the increased sensitivity observed in this study and the study by Jones et al. [4] is not obvious. It is possible that ambient temperature might have influenced the results. The present study and the study by Jones et al. [4] were conducted in tropical countries while the studies [5],[7] that found axillary temperature inaccurate were carried out in temperate countries. With a high specificity of 89.6%, it shows axillary temperature can reliably measure normal rectal temperature. Other studies have also reported high specificities ranging from 88% to 99%. [5],[6],[7]


  Conclusion Top


Axillary temperature can reliably screen for fever as well as normal body temperature. Therefore, it should be used continually in clinics to measure body temperature especially when the gold standard (rectal thermometry) is not feasible.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
El-Radhi AS, Barry W. Thermometry in paediatric practice. Arch Dis Child 2006;91:351-6.  Back to cited text no. 1
    
2.
Paes BF, Vermeulen K, Brohet RM, van der Ploeg T, de Winter JP. Accuracy of tympanic and infrared skin thermometers in children. Arch Dis Child 2010;95:974-8.  Back to cited text no. 2
    
3.
Community Paediatrics Committee, Canadian Paediatric Society. Temperature measurement in paediatrics. Paediatr Child Health 2000;5:273-6.  Back to cited text no. 3
    
4.
Jones RJ, O'Dempsey TJ, Greenwood BM. Screening for a raised rectal temperature in Africa. Arch Dis Child 1993;69:437-9.  Back to cited text no. 4
    
5.
Morley CJ, Hewson PH, Thornton AJ, Cole TJ. Axillary and rectal temperature measurements in infants. Arch Dis Child 1992;67:122-5.  Back to cited text no. 5
    
6.
Ogren JM. The inaccuracy of axillary temperatures measured with an electronic thermometer. Am J Dis Child 1990;144:109-11.  Back to cited text no. 6
    
7.
Kresch MJ. Axillary temperature as a screening test for fever in children. J Pediatr 1984;104:596-9.  Back to cited text no. 7
[PUBMED]    
8.
Craig JV, Lancaster GA, Williamson PR, Smyth RL. Temperature measured at the axilla compared with rectum in children and young people: Systematic review. BMJ 2000;320:1174-8.  Back to cited text no. 8
    
9.
Edelu BO, Ojinnaka NC, Ikefuna AN. A comparison of axillary with rectal thermometry in under 5 children. Niger Med J 2011;52:207-10.  Back to cited text no. 9
[PUBMED]  Medknow Journal  
10.
Akinbami FO, Sowunmi A. Body temperature in the Nigerian neonate - Comparison of axillary and rectal temperatures. Afr J Med Med Sci 1991;20:49-52.  Back to cited text no. 10
    


    Figures

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    Tables

  [Table 1], [Table 2]



 

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Abstract
Introduction
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