Written by Kimiko Dunbar
Spoon Feed
Temporal thermometers are at risk of inaccuracy; children ≤12 years have 2-3 times higher odds of missed fever than older peers, and Black patients were 27% more likely to receive temporal-only measurements.
Would you rather be efficient or accurate?
Temporal thermometers are frequently used, given their efficiency in assessing children for fever, especially in the pediatric emergency department. Recent data has shown lower odds of identifying fever using a temporal thermometer in adult Black patients. This retrospective cohort study assessed age- and race-based accuracy of temporal thermometry in pediatric emergency patients. Authors assessed the concordance of paired readings, defined as measurement of temporal and oral/rectal temperature within 30 minutes – this included situations where an antipyretic was given between the two measurements. Discordant readings were defined as those where one modality identified fever or hypothermia and the other did not. Among 1,526 paired readings, 26% were discordant, with children ≤12 years having 2–3 times higher odds of missed fever than older peers. Black patients were 27% more likely to receive temporal-only measurements (aOR 1.27, 95%CI 1.22–1.33). Limitations include race as a skin pigmentation proxy and unstandardized measurement practices. Temporal thermometry may systematically miss fevers, particularly in younger children and disproportionately in Black patients.
How does this change my practice?
Yikes? We use temporal thermometers in the hospital where I practice. There are some situations where fever precision is less important (i.e. a toddler with a URI); however, there are others where inaccuracy isn’t an option (febrile neonate, Kawasaki disease). That being said, this study is comparing temperatures taken up to 30 minutes apart, and a lot can happen during that time – some kids may be actively spiking a fever, which would explain why readings may differ. Regardless, it seems we shouldn’t be using temporal thermometers in the situations where it really matters and should be especially thoughtful in Black patients who are disproportionately missed.
Source
Inaccuracy of Temporal Thermometer Measurement by Age and Race. Acad Pediatr. 2025 Apr;25(3):102620. doi: 10.1016/j.acap.2024.102620. Epub 2024 Dec 15. PMID: 39681266
