Accuracy of Tactile Assessment of Fever in Children by Caregivers: A Systematic Review and Meta-analysis.

ABSTRACT

CONTEXT Fever is the most common complaint in the pediatric and emergency departments. Caregivers prefer to detect fever in their children by tactile assessment. OBJECTIVE: To summarize the evidence on the accuracy of caregivers' tactile assessment for detecting fever in children. EVIDENCE-ACQUISITION We performed a literature search of Cochrane Library, PubMed, Web of Knowledge, EMBASE (ovid), EBSCO and Google Scholar, without restriction of publication date, to identify English articles assessing caregivers' ability of detecting fever in children by tactile assessment. Quality assessment was based on the 2011 Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) criteria. Pooled estimates of sensitivity and specificity were calculated with use of bivariate model and summary receiver operation characteristics plots for meta-analysis. RESULTS: 11 articles were included in our analysis. The summary estimates for tactile assessment as a diagnostic tool revealed a sensitivity of 87.5% (95% CI 79.3% to 92.8%) and specificity of 54.6% (95% CI 38.5% to 69.9%). The pooled positive likelihood ratio was 1.93 (95% CI 1.39 to 2.67) and negative likelihood ratio was 0.23 (95% CI 0.15 to 0.36). Area under curve was 0.82 (95% CI 0.7 to 0.85). The pooled diagnostic odds ratio was 8.46 (95% CI 4.54 to 15.76). CONCLUSION: Tactile assessment of fever in children by palpation has moderate diagnostic value. Caregivers' assessment as "no fever" by touch is quite accurate in ruling out fever, while assessment as "fever" can be considered but needs confirmation.