Inaccuracy of Temporal Thermometer Measurement by Age and Race

Objective: Rapid vital sign assessment, including temperature measurement, is critical among pediatric patients presenting to the emergency department (ED). While error rates in temporal thermometry are well documented, the potential for differential error rates by demographics is not well established. Our objective was to evaluate error rates of temporal thermometers by demographic variables, specifically race and age, among pediatric patients in the ED. Methods: Pediatric patients (≤18 years old) identified as either Black or White in the medical record presenting to the ED between January 2020 and December 2022 who received at least one paired temperature measurement (temporal and oral/rectal temperature within 30 minutes) were included. Rates of discordance by demographic characteristics were then evaluated. Secondarily, we explored the characteristics of patients who received temporal thermometry only. Results: The final population included 1526 paired temperatures (1412 patients). Among all paired measurements, 26% had discordant measurements (25% in Black patients vs 26% in White patients). In the final adjusted model, children aged ≤12 years old were found to have 2–3 times higher odds of discordance than children >12 years old. Black patients were statistically significantly more likely to receive a temporal thermometer measurement only (adjusted odds ratio [aOR] 1.27, 95% confidence interval [CI]: 1.22, 1.33), even when controlling for fever-related chief complaints. Conclusions: Age ≤12 years old was associated with increased odds of missed fever by temporal thermometry. In our secondary analysis, Black patients were found to be more likely to receive temporal thermometry only. These findings highlight the need for consistent, accurate measurement protocols among pediatric patients.