HOW TO PALPATE FEVER

Most studies say that palpation of fever is inaccurate. I am not so sure. Many of the studies use oral temperature as a gold standard, which of course can be as low as 50% sensitive for true fever. These studies conclude that the mothers’ palpation over-called the diagnosis but I wonder whether rectal temperature assessment would not have proven many mothers to be correct.

 

I see people put their palm on the forehead to check for fever, and then pull it away 1 second later. I believe this is wrong on several levels. First, use the back of the hand, not the palm. The back of the hand is more sensitive to temperature. Second, don’t feel the forehead, try something less subject to the ambient environment. I often use the neck. Third, don’t pull it away, rather, leave it there. You are not feeling for whether it is warm. You are feeling for whether it is hot. I think we can tell the difference. Remember the sting of a hot tub? Hot tubs are never supposed to be above 104. Yet they really sting sometimes. Hold your hand there and if you feel that sting, it is probably a fever.

 

I found that once I used the above techniques I became a lot more accurate. I would ask skeptical nurses for rectal temperature assessment, and they would come back astonished at my predictive abilities. Palpate for the hot tub sting with the back of your hand in the axilla or neck and see if it works for you. My hope is that future studies would show better methodology.

 

Take home points:

Palpate for a fever using the back of the hand, not the palm

Palpate the neck or core body area, not the forehead

Palpate for at least 10-15 seconds

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