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Comparison of Axillary, Tympanic and Rectal Body Temperatures Using a Covariate-Adjusted Receiver Operating Characteristic Approach

Author(s): N Zare | M Namdari | F Jahanpour

Journal: Iranian Red Crescent Medical Journal
ISSN 1561-4395

Volume: 12;
Issue: 3;
Start page: 293;
Date: 2010;
Original page

Keywords: Covariate-adjusted ROC curve | Accuracy | Tympanic | Axillaries | Rectal temperature | Pediatric | Fever

Background: Accurate temperature measurement is crucial in pediatric population. Before diagnostic tests areimplemented in practice, it is suggested that their accuracy or ability to discriminate to be studied. The accuracyof a diagnostic test can be summarized in a Receiver Operating Characteristic (ROC) curve. This study wascarried out to compare the accuracy of tympanic and axillary methods with rectal measurement in children lessthan 6 years old.Methods: A total of 220 pair of ears, axillaries, and rectal sites were used to determine the body temperature inpatients aged between 3 months and 6 years, who referred to Emergency Department of Ali Asghar Hospitalaffiliated to Bushehr University of Medical Sciences. Rectal temperature (RT) was considered as gold standard.Fever was defined as RT ³ 38oC. RT, axillary, right and left tympanic temperature were measured. Measureagreement was assessed by covariate-adjusted ROC regression.Results: By comparing the area under the curves in Hanely method and the results from ROC regression analysis,we found out a significant agreement among the three measuring techniques and none of them was moreaccurate than the others.Conclusions: None of these techniques (axillary, right and left tympanic) was more accurate than the others andit is better to use a technique that is more convenient, painless, and safer than rectal temperature. We also proposeusing a modified parametric distribution-free ROC estimator which is conceptually easy and is simple toimplement with the existing softwares for comparing the accuracy of medical tests.
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