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. 2011 Nov;12(4):505-11.
doi: 10.5811/westjem.2011.2.1963.

Oral and tympanic membrane temperatures are inaccurate to identify Fever in emergency department adults

Barbara J Barnett  1 , Stacy Nunberg, Julia Tai, Martin L Lesser, Vladmir Fridman, Patricia Nichols, Richard Powell, Robert Silverman
Affiliations

Oral and tympanic membrane temperatures are inaccurate to identify Fever in emergency department adults

Barbara J Barnett et al. West J Emerg Med. 2011 Nov.

Abstract

Introduction: Identifying fever can influence management of the emergency department (ED) patient, including diagnostic testing, treatment, and disposition. We set out to determine how well oral and tympanic membrane (TM) temperatures compared with rectal measurements.

Methods: A convenience sample of consecutively adult ED patients had oral, TM, and rectal temperatures performed within several minutes of each other. Descriptive statistics, Bland-Altman agreement matrices with 95% confidence interval (CI), and measures of test performance, including sensitivity, specificity, predictive values, and interval likelihood ratios were performed.

Results: A total of 457 patients were enrolled with an average age of 64 years (standard deviation: 19 years). Mean temperatures were: oral (98.3°F), TM (99.6°F), and rectal (99.4°F). The mean difference in rectal and oral temperatures was 1.1°F, although there was considerable lack of agreement between oral and rectal temperatures, with the oral temperature as much as 2.91°F lower or 0.74°F higher than the rectal measurement (95% CI). Although the difference in mean temperature between right TM and rectal temperature was only 0.22°F, the right TM was lower than rectal by up to 1.61°F or greater by up to 2.05°F (95% CI). Test performance varied as the positive predictive value of the oral temperature was 97% and for tympanic temperature was 55% (relative to a rectal temperature of 100.4°F or higher). Comparative findings differed even at temperatures considered in the normal range; among patients with an oral temperature of 98.0 to 98.9, 38% (25/65) were found to have a rectal temperature of 100.4 or higher, while among patients with a TM of 98.0 to 98.9, only 7% (10/134) were found to have a rectal temperature of 100.4 or higher.

Conclusion: The oral and tympanic temperature readings are not equivalent to rectal thermometry readings. Oral thermometry frequently underestimates the temperature relative to rectal readings, and TM values can either under- or overestimate the rectal temperature. The clinician needs to be aware of the varying relationship between oral, TM, and rectal temperatures when interpreting readings.

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Conflict of interest statement

Conflicts of Interest: By the WestJEM article submission agreement, all authors are required to disclose all affiliations, funding sources, and financial or management relationships that could be perceived as potential sources of bias. The authors disclosed none.

Figures

Figure 1.
Figure 1.
Bland–Altman plot of oral and rectal temperatures. To display the relationships between rectal (reference) and oral temperatures, the difference between the rectal and oral measurements (see vertical axis) was plotted as a function of the mean of the 2 measurements (see horizontal axis).
Figure 2.
Figure 2.
Bland–Altman plot of right tympanic membrane (TM) and rectal temperatures. To display the relationship between the rectal (reference) and the tympanic temperatures, the difference between the rectal and tympanic measurements (see vertical axis) was plotted as a function of the mean of the 2 measurements (see horizontal axis).
Figure 3.
Figure 3.
Receiver operating characteristic curve for oral temperature relative to the study definition of rectal fever. The best estimate cutpoint for oral readings was 98.9°F.
See this image and copyright information in PMC

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