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Lack of Accuracy of Body Temperature for Detecting Serious Bacterial Infection in Febrile Episodes

De, Sukanya MB BS, MD, PhD, FRACP*†; Williams, Gabrielle J. BSc, MPH, PhD*†; Teixeira-Pinto, Armando BSc, AM, PhD*; Macaskill, Petra BA, MApp Stat, PhD*; McCaskill, Mary BSc, Dip Paeds, MB BS, FACEM; Isaacs, David MB BChir, MD, FRACP, FRCPCH§; Craig, Jonathan C. MB ChB, DipCH, MM, PhD, FRACP*†¶

The Pediatric Infectious Disease Journal: September 2015 - Volume 34 - Issue 9 - p 940–944
doi: 10.1097/INF.0000000000000771
Original Studies

Background: Body temperature is a time-honored marker of serious bacterial infection, but there are few studies of its test performance. The aim of our study was to determine the accuracy of temperature measured on presentation to medical care for detecting serious bacterial infection.

Methods: Febrile children 0–5 years of age presenting to the emergency department of a tertiary care pediatric hospital were sampled consecutively. The accuracy of the axillary temperature measured at presentation was evaluated using logistic regression models to generate receiver operating characteristic curves. Reference standard tests for serious bacterial infection were standard microbiologic/radiologic tests and clinical follow-up. Age, clinicians’ impression of appearance of the child (well versus unwell) and duration of illness were assessed as possible effect modifiers.

Results: Of 15,781 illness episodes 1120 (7.1%) had serious bacterial infection. The area under the receiver operating characteristic curve for temperature was 0.60 [95% confidence intervals (CI): 0.58–0.62]. A threshold of ≥38°C had a sensitivity of 0.67 (95% CI: 0.64–0.70), specificity of 0.45 (95% CI: 0.44–0.46), positive likelihood ratio of 1.2 (95% CI: 1.2–1.3) and negative likelihood ratio of 0.7 (95% CI: 0.7–0.8). Age and illness duration had a small but significant effect on the accuracy of temperature increasing its “rule-in” potential.

Conclusion: Measured temperature at presentation to hospital is not an accurate marker of serious bacterial infection in febrile children. Younger age and longer duration of illness increase the rule-in potential of temperature but without substantial overall change in its test accuracy.

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From the *Screening and Test Evaluation Program, Sydney School of Public Health, The University of Sydney, Sydney, Australia; Centre for Kidney Research, Department of Emergency Medicine, §Department of Infectious Disease, and Department of Nephrology, The Children’s Hospital at Westmead, Sydney, Australia.

Accepted for publication April 20, 2015

This is a substudy of the Febrile Evaluation of Children in the Emergency Room (FEVER) study, which was funded by the National Health and Medical Research Council of Australia (program grant numbers 211205 and 402764). The funding source had no influence on study design, data collection, analysis, interpretation of data, writing of the report, or on the decision to submit the paper for publication. The authors have no conflicts of interest to disclose.

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Address for correspondence: Sukanya De, Centre for Kidney Research, The Children’s Hospital at Westmead, Westmead, NSW 2145, Australia. E-mail:

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