The article by Press and Quinn,1 as well as the accompanying editorial by Rice,2 are critically flawed by an important assumption: rectal temperature represents the reference standard for temperature assessment in children. While it is true that many physicians use rectal temperature to screen for bacteremia and other bacterial infections, a cursory review of the medical literature (as well as clinical experience) will reveal that rectal temperature lacks both sensitivity and specificity to detect these diseases and is, therefore, of very limited usefulness. More importantly, for this study, rectal temperature is poorly correlated with core body temperature when the body temperature is changing (as with fever) and, in fact, may actually diverge from the core body temperature during rapid body temperature changes.3-11 Dr Rice's assertion that "rectal thermometry remains the standard for measuring core body temperature in this age group"2(p544) shows a lack of understanding of temperature physiology. A reference standard for body temperature measurement should reflect the core body temperature accurately. A useful diagnostic test should effectively rule in and rule out diseases; rectal temperature does neither.
Chamberlain JM. Pacifier Thermometer Comment. Arch Pediatr Adolesc Med. 1998;152(2):206–207. doi:10.1001/archpedi.152.2.206
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