SUBJECTIVE ASSESSMENT OF FEVER BY PARENTS - COMPARISON WITH MEASUREMENT BY NONCONTACT TYMPANIC THERMOMETER AND CALIBRATED RECTAL GLASS MERCURY THERMOMETER

Study objective: To assess the ability of parents to subjectively eval uate their children for fever and to compare their assessments with te mperature measurements made with the use of a noncontact tympanic (NCT ) or rectal glass mercury thermometer. A secondary goal was to assess how well a recently developed definition of fever for NCT thermometers , when used in the ear-equivalent mode (temperature of 37.7 degrees C or more), performed in a clinical situation. Methods: This 6-month pro spective observational study employed a convenience sample of 180 chil dren, aged birth to 4 years, who presented to the emergency department of a tertiary care children's hospital. Parents were asked to subject ively assess whether their child had a fever. The child's temperature was then measured with an NCT thermometer (three times in the rectal-e quivalent mode and three times in the actual-ear mode). Both the subje ctive assessment and the NCT temperatures were compared with the recta l temperature measured by a rectal glass mercury thermometer. Results: The mean age of participants was 14.6+/-11.8 months (range, 2 days to 48 months); 56% were boys. The sensitivity of parental detection of f ever by subjective means was 81.8% and the specificity 76.5%. The pare nt and the rectal glass thermometer agreed 79% of the time (95% confid ence interval [CI], 73% to 85%). The sensitivity of the first temperat ure reading obtained with the NCT thermometer in rectal-equivalent mod e was 74.7%, and the specificity was 96.3%. The NCT thermometer and th e rectal glass thermometer agreed 84% of the time (95% CI, 78% to 89%) . Use of the proposed definition of fever for NCT thermometers, when u sed in the ear-equivalent mode, caused sensitivity of a single measure ment for fever to drop to 53.5%. Conclusion: Parental subjective asses sment of fever agreed with the presence of fever as measured by rectal glass thermometer in 79% of cases. Specificity was improved with the use of the NCT thermometer. The recently proposed definition for fever for NCT thermometers, when they are used in the ear-equivalent mode, does not appear to be validated by the current data.