6 th of June Olive Jackie Namugga

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1 Determination of the validity and reliability of axillary and tympanic body temperature measurements among Infants at Mulago national referral hospital, Uganda 6 th of June 2018 Olive Jackie Namugga

2 Background. Body temperature is a vital sign commonly used in disease diagnosis, management and prognosis Fever and hypothermia are common signs of severe illness and are stand-alone signs for defining severe illness in young infants ( 60 days of age) Improved measurement of body temperature is paramount for improving diagnosis and management of severe illness in young infants, and could contribute to increase child survival

3 Background Body temperature measurements: Axillary Rectal Infrared tympanic Data on the reliability and validity of the various thermometry methods, especially among young infants, is lacking Even rectal measurements (considered gold standard) do not reflect the true core body temperature in times of rapid temperature changes It is not clear whether axillary or tympanic thermometry can satisfactorily be used instead of rectal thermometry in pediatric practice

4 Primary Objective To determine the reliability (precision) and validity (accuracy) of identifying fever or hypothermia with tympanic membrane and axillary temperature measurements among infants aged 0-28 days and days in Mulago national referral hospital in Kampala

5 Specific Objectives To estimate the reliability of rectal, tympanic membrane and axillary temperature measurements among infants having rectal temperatures ranging from below to above the normal range To estimate the validity of tympanic membrane and axillary measurements of body temperature in identifying fever using rectal measurement as the gold standard To estimate the validity of tympanic membrane and axillary measurements of body temperature in identifying hypothermia using rectal measurement the gold standard

6 Methods Study design cross-sectional study Study site Mulago national referral hospital, Uganda o Acute care unit (ACU), o General pediatric wards o Postnatal wards Study Population. two infant categories; o 349 infants aged 0 to 28 days (neonates) o 211 young infants aged 29 to 60 days.

7 Results A total of 189 infants enrolled so far (the study is ongoing) Baseline characteristics. Variable Age 0-28days 29-60days Sex Male Female n(%) 186 (98.4) 3 (1.6) 94 (47.7) 95 (50.3) Mean (SD) differences Mean (SD) difference 95% CI Axillary-Tympanic -0.8 (1.2) Axillary-Rectal -0.4 (0.2) Tympanic-Rectal -0.7 (1.2)

8 Results Reliability. Absolute TEM ( 0 C) Coefficient of Variation (TEM/Mean) % Axillary thermometry % Tympanic thermometry % Rectal thermometry %

9 Correlation Pearson correlation Results o Between measurements Pearson correlation First and second axillary reading 0.99 First and second tympanic reading 0.98 First and second rectal reading 0.98 o Between tests Pearson correlation Axillary -Tympanic 0.55 Axillary-Rectal 0.91 Tympanic-Rectal 0.51

10 Sensitivity & specificity for identifying Fever Results axillary Sensitivity & specificity for identifying hypothermia Rectal Readings 38.0 o C <38.0 o C Total Rectal readings 36.0 o C >36.0 o C Total Axillary Readings 37.5 o C <37.5 o C Total Axillary Readings 35.5 o C >35.5 o C Total Sensitivity: [29/(29+3)] 90.6% (95%CI 75%, 98%) Specificity: [113/(9+113)]92.6% (95%CI 86.5%,96.6%) Sensitivity:[15/(15+20) 42.9%(95%CI 26.3%,60.6 %) Specificity: [113/(0+113)]100% (95%CI 96.8%, 100%)

11 Results- tympanic Sensitivity & Specificity for identifying fever 38.0 o C Rectal readings <36.0 o C Total 37.8 o C Sensitivity & Specificity for identifying hypothermia S Rectal readings 36.0 o >36.0 o C Total 35.5 o C Tympanic Readings <37.8 o C Total >35.5 o C Total Sensitivity:[[31/(31+1)] 96.9% (95%CI 83.8%, 99.9%) Specificity: [101/(20+101)]83.5% (95%CI 75.6%, 89.6%) Sensitivity:[[ 5/(5+28)] 15.2% (95% CI 5.1%-31.9%) Specificity :[[101/(1+ 101)] 99.0% (95% CI94.7%- 100%)

12 Discussion The mean difference was smaller between axillary and rectal measurements (0.4 o C) compared to between tympanic and rectal measurements (0.7 o C). Axillary measurements had the least TEM (0.10 o C), followed by Tympanic measurements (0.11 o C) and rectal (0.16 o C ). The strongest inter-method correlation (r=0.91) is observed between axillary and rectal measurements as compared to between tympanic and rectal (r=0.51) The correlation between the first and second reading is strongest in the axillary readings

13 Discussion Tympanic measurements have a higher sensitivity for detecting fever compared to Axillary measurements. These findings are in line with those from El-Radhi and Patel, (2006) Axillary and especially tympanic measurements show low sensitivity in detecting hypothermia The mean difference between axillary and rectal temperature is -0.4 o c which is relatively consistent with the commonly used mean difference of 0.5 o C used to estimate rectal from axillary measurements

The Difference of Tympanic Temperature According to Insertion Methods of Tympanic Thermometer Probe

, pp.612-616 http://dx.doi.org/10.14257/astl.2015.120.122 The Difference of Tympanic Temperature According to Insertion Methods of Tympanic Thermometer Probe Seung-Kyo Chaung 1 1 Department of Nursing,