Axillary, Oral and Rectal Routes of Temperature Measurement During Treatment of Acute Kawasaki Disease

Background: Important therapeutic decisions are made based on the presence or absence of fever in patients with Kawasaki disease (KD), yet no standard method or threshold exists for temperature measurement during the diagnosis and treatment of these patients. We sought to compare surface and internal (rectal or oral) routes of temperature measurement for the detection of fever as a marker of treatment resistance. Methods: From a randomized, placebo-controlled trial of infliximab as an adjunct to primary intravenous immunoglobulin treatment for acute KD, we collected concurrent (within 5 minutes) axillary and internal temperature measurements and performed receiver-operating characteristic and Bland-Altman analyses. We also determined the ability of surface temperatures to detect treatment resistance defined by internal temperature measurements. Results: Among 452 oral-axillary and 439 rectal-axillary pairs from 159 patients, mean axillary temperatures were 0.25 and 0.43 degrees C lower than oral and rectal temperatures and had high receiver-operating characteristic areas under curves. However, axillary temperatures >= 38.0 degrees C had limited sensitivity to detect fever defined by internal temperatures. Axillary thresholds of 37.5 and 37.2 degrees C provided maximal sensitivity and specificity to detect oral and rectal temperatures >= 38.0 degrees C, respectively. Conclusions: Axillary temperatures are an insensitive metric for fevers defining treatment resistance. Clinical trials should adopt temperature measurement by the oral or rectal routes for adjudication of treatment resistance in KD.