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. 2021 Sep;8(5):2705-2721.
doi: 10.1002/nop2.831. Epub 2021 Mar 18.

Threshold for defining fever varies with age, especially in children: A multi-site diagnostic accuracy study

Rajesh Kasbekar  1 , Aftab Naz  2 , Lorenzo Marcos  3 , Yingjie Liu  4 , Kristine Hendrickson  1 , James C Gorsich  1 , Matt Baun  1
Affiliations

Threshold for defining fever varies with age, especially in children: A multi-site diagnostic accuracy study

Rajesh Kasbekar et al. Nurs Open. 2021 Sep.

Abstract

Aim: The American Academy of Pediatrics and the European Centre for Pediatric and Adolescent Medicine guideline define fever as a temperature >38.0°C for all ages and recommend use of rectal thermometers in children <3 years. Based on new literature, this definition of fever using a fixed threshold of 38.0°C needs to be re-examined.

Design: A multi-site diagnostic accuracy study was conducted to compare an "age-based" threshold model with a "fixed" threshold over 38.0°C on a total of 894 patients of which 373 were ill.

Methods: The "age-based" and "fixed" threshold fever determinations were then compared to a clinical categorization ("well" or "ill") conducted by a clinician through a comprehensive examination.

Results: The sensitivity and accuracy for the age-based thresholds were found to be superior to the fixed thresholds in all ages and current ear thermometers were found equivalent to rectal thermometers in infants <6 months.

Keywords: adult; age-based; body temperature; children; fever; infant; newborn; paediatrics; parents; sensitivity; specificity; thermometer.

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Conflict of interest statement

The study was implemented, and the data were collected by third‐party independent investigators who had no financial interest in the products, technology or methodology discussed in this paper. The analysis and manuscript preparation were done by Kaz USA, Inc., a Helen of Troy Company in collaboration with the third‐party investigators. The study protocol is available upon request.

Figures

FIGURE 1
FIGURE 1
Comparison of accuracy for fever determination: Overall and Each Age Strata—Test versus Reference
FIGURE 2
FIGURE 2
Comparison of sensitivity and specificity for fever determination: Overall and Each Age Strata—Test versus Reference
FIGURE 3
FIGURE 3
Receiver Operating Curve Test Device (in Blue) versus Reference Device (in Red)
FIGURE 4
FIGURE 4
Bland–Altman Chart—Overall
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