A5V4d

Thermometers and the detection of fever
4 Healthcare professionals who routinely use disposable chemical dot thermometers
should consider using an alternative type of thermometer when multiple temperature
measurements are required. [2007]
5 Forehead chemical thermometers are unreliable and should not be used by
healthcare professionals. [2007]
Number Research recommendation
RR1 Measuring temperature in young babies: tympanic versus axilla electronic versus
axilla chemical dot versus temporal artery. [2007]
4.3 Subjective detection of fever by parents and carers
Not all families own a thermometer and parents and carers often attempt to confirm that their child
has a fever by subjective means. This is usually done by placing a hand over the child’s forehead or
other part of the body surface. Most guidelines and review articles do not refer to subjective methods
of detecting fever. The GDG considered it important to determine whether subjective detection of
fever is accurate and should be considered a valid entry point into this guideline.
Review question
How accurate is the subjective detection of fever by parents and carers compared with the detection
of fever with a thermometer?
Narrative evidence
Five EL II studies, 86–90 one EL III prospective cohort study 91 and one EL III research letter 59 investigating
the diagnostic accuracy of subjective measurement to detect fever were found. Overall, most
of the studies were conducted in resource-poor settings such as Malawi 88 or Zimbabwe, 59 the age of
children included varied (e.g. 2 days to 48 months 87 to 1 month to 18 years 90 ) and the authors used
different reference standards (for instance, one compared perceived fever with oral temperature
= 37.8°C or rectal temperature = 38.3°C measured by either mercury or digital thermometer 86 ). The
other prospective cohort study 87 used tympanic temperature measured by non-contact tympanic
thermometer and rectal temperature by mercury thermometer as standard. The overall finding
suggested that parental perceived fever had reasonable diagnostic accuracy with the sensitivity of
detection of fever ranging from 74% 86 to 97% 88 and specificity ranging from 19% 88 to 86% 86 in EL II
studies. Sensitivities and specificities as high as 94% and 90.6%, respectively, have been reported by
EL II studies. 59,91
Evidence summary
Subjective detection of fever by parents and carers has been relatively well studied but there are no
UK studies. The sensitivity of palpation for the detection of fever ranged from 74% to 97%. (EL II).
Five of the six studies that quoted specificity gave values between 67% and 91%; the other gave a
value of 19%. (EL II)
GDG translation
The GDG noted that, although there had been no direct comparisons, the sensitivity and specificity of
detecting fever by palpation were comparable with those reported for axillary and tympanic
thermometers. The GDG therefore decided that detection of fever by palpation was probably as good
as the other alternatives to oral and rectal temperature measurements. The GDG considered that it
was important for these facts to be recognised by healthcare professionals.
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