Routine temperature checks: Is less more?

Taking temperature at all well-child visits triggers more antibiotic prescriptions and less testing compared with not making this a standard practice. Routine temperature checks also detect incidental fever, leading to more interventions and deferred vaccination. Those were the primary findings of an analysis of data from well-child visits at a network of 24 primary care clinics in California.

Investigators categorized clinics that measured temperatures at almost all well-child visits (> 90%) as practicing “routine measurement” and those that did so at a few such visits (< 20%) as performing “occasional measurement.” Sixteen of the 24 clinics (67%) were in the former category, and the remaining 8 (33%) were in the latter. The mean patient age in both groups was 5 years. Overall, temperature was measured at more than 155,527 (58.9%) well-child visits.

Antibiotics were prescribed a bit more frequently at clinics that measured temperature routinely rather than occasionally (1.7% vs 1.4%). However, the odds of obtaining diagnostic testing, such as C-reactive protein, complete blood cell count, rapid influenza or streptococcal test, throat swab, or urine culture, were lower at routine than occasional measurement clinics (1.3% vs 1.4%). These differences remained after adjustment for confounding factors.

At 0.2% of routine measurement clinic visits, temperature taking detected fevers, 17.4% of which were classified as probable incidental fever. This finding was associated with an increase in antibiotic prescriptions and diagnostic testing. In addition, at about half of such visits, vaccines were deferred, most often (in 75% of instances) until the next well-child visit.

The authors noted that although the findings showed a low overall rate of incidental fever detection, this “may trigger overuse of health care resources and unnecessary vaccine deferral.” The practice of routinely measuring temperature at well-child visits therefore merits additional consideration of harm vs benefits, they said.

Thoughts from Dr. Farber

When I first started in pediatrics, children received yearly hemoglobin and urinalysis tests—until we realized they were not useful. The same should probably happen with temperature readings, although the habit will be hard to break. Remember, a mild illness, including fever, is not a contraindication to vaccination, so it is not necessary to measure temperature in a well-appearing child.

Reference

1. Dang R, Patel AI, Marlow J, Weng Y, Wang ME, Schroeder A. Frequency and consequences of routine temperature measurement at well-child visits. Pediatrics. 2022;149(1):e2021053412. doi:10.1542/ peds.2021-053412