Detection of fever in children emergency care: comparisons of tactile and rectal temperatures in Nigerian children.

BACKGROUND

Clinical thermometry is the objective method for temperature measurements but tactile assessment of fever at home is usually the basis for seeking medical attention especially where the cost and level of literacy preclude the use of thermometers. This study was carried out to determine the reliability of tactile perception of fever by caregivers, nurses and house physicians in comparison to rectal thermometry and also the use of commonly practiced surface of the hand in the care of ill children. All caregivers of children aged 6 to 59 months who presented to the emergency department were approached consecutively at the triage stage but 182 children participated. Each child had tactile assessment of fever using palmar and dorsal surfaces of the hand by the caregivers, House Physicians and Nursing Officers. Rectal temperature was also measured and read independently by nurses and house physicians. Comparisons were made between tactile assessments and thermometer readings using a cut-off for fever, 38.0 degrees C and above.

FINDINGS

The caregivers' perception of fever had a sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of 95%, 23%, 66% and 73%, respectively compared with 93%, 26%, 67% and 69%, respectively for nursing officers. Irrespective of the groups studied, 77.1% of 336 assessors opined that the dorsal surface of the hand was more sensitive in tactile assessment of temperature and the frequently used site for assessment of fever were the head (35.6%) and neck (33.3%). Tactile assessment of temperature over-detected fever in >/= 24% of cases among the three groups of assessors.

CONCLUSIONS

The present study suggests that tactile assessment of temperature may over estimate the prevalence of fever, it does not detect some cases and the need for objective measurement of temperature is emphasised in paediatric emergency care.