How reliable is axillary temperature measurement?

Falzon, A; Grech, Victor; Caruana, Bruce J.; Magro, A.; Attard-Montalto, Simon

doi:10.1080/08035250310009220

Cited by 17 publications

(9 citation statements)

References 12 publications

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“…The surface and internal mean differences we observed are consistent with previously reported differences between rectal and axillary 17-19 and between oral and axillary temperatures. 19,20 Our observation that the mean difference between axillary and rectal temperatures was greater than between axillary and oral temperatures is consistent with previous studies of hospitalized pediatric patients with various clinical diagnoses.…”

Section: Discussionsupporting

confidence: 92%

“…19,20 Our observation that the mean difference between axillary and rectal temperatures was greater than between axillary and oral temperatures is consistent with previous studies of hospitalized pediatric patients with various clinical diagnoses. 19 Axillary temperature measurement poorly detects elevated temperatures among hospitalized infants, even with an axillary threshold of 37.2°C. 21 A simple conversion between surface and internal temperature 18,20 would be useful for clinical care and research in KD.…”

Section: Discussionsupporting

confidence: 92%

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Axillary, Oral and Rectal Routes of Temperature Measurement During Treatment of Acute Kawasaki Disease

Kanegaye

Jones

Burns

et al. 2016

Pediatric Infectious Disease Journal

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Background Important therapeutic decisions are made based on the presence or absence of fever in patients with Kawasaki disease (KD), yet no standard method or threshold exists for temperature measurement during the diagnosis and treatment of these patients. We sought to compare surface and internal (rectal or oral) routes of temperature measurement for the detection of fever as a marker of treatment resistance. Methods From a randomized, placebo-controlled trial of infliximab as an adjunct to primary intravenous immunoglobulin treatment for acute KD, we collected concurrent (within 5 minutes) axillary and internal temperature measurements and performed receiver-operating characteristic and Bland-Altman analyses. We also determined the ability of surface temperatures to detect treatment resistance defined by internal temperature measurements. Results Among 452 oral-axillary and 439 rectal-axillary pairs from 159 patients, mean axillary temperatures were 0.25°C and 0.43°C lower than oral and rectal temperatures and had high receiver-operating characteristic areas-under-curves. However, axillary temperatures ≥38.0°C had limited sensitivity to detect fever defined by internal temperatures. Axillary thresholds of 37.5°C and 37.2°C provided maximal sensitivity and specificity to detect oral and rectal temperatures ≥38.0°C, respectively. Conclusions Axillary temperatures are an insensitive metric for fevers defining treatment resistance. Clinical trials should adopt temperature measurement by the oral or rectal routes for adjudication of treatment resistance in KD.

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Section: Discussionsupporting

confidence: 92%

Section: Discussionsupporting

confidence: 92%

Axillary, Oral and Rectal Routes of Temperature Measurement During Treatment of Acute Kawasaki Disease

Kanegaye

Jones

Burns

et al. 2016

Pediatric Infectious Disease Journal

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“…Although simultaneous axillary and rectal measurements in infants may yield slightly different results, axillary measurements are consistently lower than rectal measurements. 18, 19 A review of 16 studies comparing simultaneous axillary and rectal temperature measurements in newborns and infants demonstrated that rectal-axillary difference was smaller among newborns than among older infants and children, with a mean difference of just 0.17°C (95% limits of agreement, −0.15°C–0.5°C) in newborns vs. 0.92°C (−0.15°C–1.98°C) in infants. 28 A recent study of passive cooling during transport noted poor correlation of simultaneous skin probe and rectal temperatures, but good agreement between rectal and axillary temperatures (mean difference 0.1°C in 61 paired measurements).…”

Section: Discussionmentioning

confidence: 99%

“…1, 2 The range 32.5–34.5 was chosen because core temperature is almost always higher than axillary temperature and because newborns in this study were monitored using axillary measurements during transport to CHB. 18, 19 The American Academy of Pediatrics guidelines were used to define the range of normal newborn body temperature of 36.5–37.4°C, measured in the axilla. 20 In our NICU and on newborn transports, the protocol is to monitor temperature in the axilla rather than the rectum unless there is a significantly abnormal measurement by axilla that requires verification.…”

Section: Methodsmentioning

confidence: 99%

Passive cooling during transport of asphyxiated term newborns

et al. 2012

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Objective To evaluate the efficacy and safety of passive cooling during transport of asphyxiated newborns. Study Design Retrospective medical record review of newborns with perinatal asphyxia transported for hypothermia between July 2007 and June 2010. Results Forty-three newborns were transported, 27 of whom were passively cooled. Twenty (74%) passively cooled newborns arrived with axillary temperature between 32.5 and 34.5 °C. One newborn (4%) arrived with a subtherapeutic temperature, and 6 (22%) had temperatures >34.5 °C. Time from birth to hypothermia was significantly shorter among passively cooled newborns compared with newborns not cooled (215 vs. 327 minutes, p<0.01), even though time from birth to arrival was similar (252 vs. 259 minutes, p=0.77). There were no significant adverse events related to passive cooling. Conclusions Exclusive passive cooling for hypoxic-ischemic encephalopathy results in significantly earlier achievement of effective therapeutic hypothermia without significant adverse events.

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“…We chose the right axillary temperature as a reference because it is less invasive than rectal temperature. There are conflicting results regarding the accuracy and precision of axillary temperature [13,14,15]. However, it has been reported that in 108 term and preterm infants (29-41 weeks of gestation) who were clinically stable, the mean axillary (36.8 ± 0.4°C) and rectal (36.8 ± 0.5°C) temperatures were similar [16].…”

Section: Discussionmentioning

confidence: 99%

Temperature Probe Placement during Preterm Infant Resuscitation: A Randomised Trial

et al. 2017

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Background: Hypothermia on admission to intensive care is associated with poor outcomes in preterm infants. The neonatal resuscitation program recommends the use of servo-control thermoregulation during resuscitation. Very little evidence exists to guide optimal temperature probe placement in the delivery room. Objective: The aim of this work was to determine, in moderately preterm infants, if temperature probe placement in the dorsal, thoracic, or axillary area during delivery room resuscitation would result in differing temperatures on admission to the neonatal intensive care unit (NICU). Methods: A randomised trial with 3 arms was conducted. In total, 122 inborn preterm infants born between 28^0/7 and 35^6/7 weeks of gestational age were recruited. The infants were randomly assigned to thermal probe placement in the left lower back, left upper thorax, or left axilla immediately after birth. Temperature was servo-controlled using an infant resuscitation table set to 36.5°C. The primary outcome was axillary temperature at admission to the NICU before transfer to a closed isolette, recorded with a digital thermometer. The secondary outcomes assessed were temperature within the target range (36.5-37.5°C), hypothermia (<36.5°C), and hyperthermia (>37.5°C). Results: All 122 infants were available for outcome analysis. The groups were comparable for birthweight, gestational age, and sex. The mean admission temperature was comparable between the 3 probe positions (mean, 95% CI): dorsum (36.7°C, 36.6-36.8), thorax (36.8°C, 36.7-36.9), and axilla (36.7°C, 36.6-36.9), p = 0.43. The proportion of infants with admission temperatures in the target range was comparable (87.2, 81.4, and 72.5% respectively), p = 0.44. Conclusion: Dorsal, thoracic, or axillary temperature probe positioning during resuscitation yield similar admission temperatures in moderately preterm infants. Further studies are required in infants below 28 weeks of gestation to determine the best practice.

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How reliable is axillary temperature measurement?

Abstract: Axillary temperatures in young children do not reliably reflect oral/rectal temperatures and should therefore be interpreted with caution.

Cited by 17 publications

References 12 publications

Axillary, Oral and Rectal Routes of Temperature Measurement During Treatment of Acute Kawasaki Disease

Axillary, Oral and Rectal Routes of Temperature Measurement During Treatment of Acute Kawasaki Disease

Passive cooling during transport of asphyxiated term newborns

Temperature Probe Placement during Preterm Infant Resuscitation: A Randomised Trial

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