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


N Zare 1 , * , M Namdari 2 , F Jahanpour 3

1 Associate Professor of Department of Biostatic, Faculty of Medicine, Shiraz University of Medical Sciences, [email protected], Fars, Iran

2 Department of Biostatics, Shiraz University of Medical Sciences, Fars, Iran

3 Department of Nursing and Midwifery, Bushehr University of Medical Sciences, Iran

How to Cite: Zare N, Namdari M, Jahanpour F. Comparison of Axillary, Tympanic and Rectal Body Tem-peratures Using a Covariate-Adjusted Receiver Operating Characteristic Approach, Iran Red Crescent Med J. Online ahead of Print ; 12(3):293-297.


Iranian Red Crescent Medical Journal: 12 (3); 293-297
Article Type: Research Article
Received: August 10, 2009
Accepted: January 25, 2010




Background: Accurate temperature measurement is crucial in pediatric population. Before diagnostic tests are implemented in practice, it is suggested that their accuracy or ability to discriminate to be studied. The accuracy of a diagnostic test can be summarized in a Receiver Operating Characteristic (ROC) curve. This study was carried out to compare the accuracy of tympanic and axillary methods with rectal measurement in children less than 6 years old.


Methods: A total of 220 pair of ears, axillaries, and rectal sites were used to determine the body temperature in patients aged between 3 months and 6 years, who referred to Emergency Department of Ali Asghar Hospital affiliated to Bushehr University of Medical Sciences. Rectal temperature (RT) was considered as gold standard. Fever was defined as RT38oC. RT, axillary, right and left tympanic temperature were measured. Measure agreement 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 more accurate than the others.


Conclusions: None of these techniques (axillary, right and left tympanic) was more accurate than the others and it is better to use a technique that is more convenient, painless, and safer than rectal temperature. We also propose using a modified parametric distribution-free ROC estimator which is conceptually easy and is simple to implement with the existing softwares for comparing the accuracy of medical tests.



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

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