Aim: To assess whether axillary temperature measurements reliably reflect oral/rectal temperature measurements. Methods: This observational study compared paired axillary‐rectal and axillary‐oral temperatures in a general paediatric ward with the participation of 225 children aged ≤4 y and 112 children aged between 4 and 14 y. Results: Changes in oral/rectal and axillary temperatures correlated significantly (p < 0.0001). However, axillary temperature measurements were significantly lower than both oral (mean ‐0.56°C, SD 0.76°C) and rectal measurements (0.38°C; SD 0.76°C). Ninety‐five percent of axillary measurements fell within a 2.5–3°C range around respective paired oral/rectal measurements. The mean difference increased with increasing temperature, and was 0.4°C at low body temperatures, and over 1°C with a fever of 39°C. Neither seasonal fluctuations nor the amount of clothing worn influenced this difference. Conclusion: Axillary temperatures in young children do not reliably reflect oral/rectal temperatures and should therefore be interpreted with caution.

The Rapid Diagnostic Clinic (RDC) was introduced to comply with NICE recommendations for improving head and neck cancer services (National Institute of Clinical Excellence 2004 Improving outcomes in head and neck cancer: the manual. NICE, London). It provides multi-modality specialist assessment for new referrals, with on-site sonography and cytology. We have critically appraised the efficacy of our RDC, with respect to its impact on patients' timelines and outcomes. A retrospective audit of new referrals to the head and neck clinic during a 6-month period was conducted (pre-RDC period); areas in delay in patients reaching a definitive outcome were identified. Following implementation of the RDC, a second cycle, prospective audit was performed and its impact on timelines for patients' journey and outcomes determined. One hundred and ninety-seven patients were seen during the pre-RDC period. The average time from referral to being seen was 11 days for 2-week wait (2WW) referrals and 34 days for other sources. During the RDC period, 299 patients were seen in total. The average waiting time was reduced to 9 days for 2WW referrals and 23 days for other referrals. During the RDC period, over one-third of patients utilised the provision of ultrasound ± FNAC, and consequently, the majority reached a definitive outcome (discharged or scheduled for surgery) following their first consultation. This was a significant improvement compared to the pre-RDC period, where the main outcome was referral for an investigation, with consequently longer waiting time for surgery. We report the first study to consider the effect of a 'one-stop' clinic on patients' journey timelines and outcomes. Our study has shown that the RDC provides an efficient and effective system, which facilitates the patients' pathway to a definitive management plan.

Axillary temperatures in young children do not reliably reflect oral/rectal temperatures and should therefore be interpreted with caution.

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BACKGROUND AND PURPOSE: Diagnosis of coronavirus disease 2019 (COVID-19) relies on clinical features and reverse-transcriptase polymerase chain reaction testing, but the sensitivity is limited. Carotid CTA is a routine acute stroke investigation and includes the lung apices. We evaluated CTA as a potential COVID-19 diagnostic imaging biomarker. MATERIALS AND METHODS: This was a multicenter, retrospective study (n ¼ 225) including CTAs of patients with suspected acute stroke from 3 hyperacute stroke units (March-April 2020). We evaluated the reliability and accuracy of candidate diagnostic imaging biomarkers. Demographics, clinical features, and risk factors for COVID-19 and stroke were analyzed using univariate and multivariate statistics. RESULTS: Apical ground-glass opacification was present in 22.2% (50/225) of patients. Ground-glass opacification had high interrater reliability (Fleiss k ¼ 0.81; 95% CI, 0.68-0.95) and, compared with reverse-transcriptase polymerase chain reaction, had good diagnostic performance (sensitivity, 75% [95% CI, 56-87]; specificity, 81% [95% CI, 71-88]; OR ¼ 11.65 [95% CI, 4.14-32.78]; P , .001) on multivariate analysis. In contrast, all other contemporaneous demographic, clinical, and imaging features available at CTA were not diagnostic for COVID-19. The presence of apical ground-glass opacification was an independent predictor of increased 30-day mortality (18.0% versus 5.7%, P ¼ .017; hazard ratio ¼ 3.51; 95% CI, 1.42-8.66; P ¼ .006). CONCLUSIONS: We identified a simple, reliable, and accurate COVID-19 diagnostic and prognostic imaging biomarker obtained from CTA lung apices: the presence or absence of ground-glass opacification. Our findings have important implications in the management of patients presenting with suspected stroke through early identification of COVID-19 and the subsequent limitation of disease transmission. ABBREVIATIONS: BSTI ¼ British Society of Thoracic Imaging; COVID-19 ¼ coronavirus disease 2019; GGO ¼ ground-glass opacification; IRR ¼ interrater reliability; RT-PCR ¼ reverse-transcriptase polymerase chain reaction; SARS-CoV-2 ¼ Severe Acute Respiratory Syndrome coronavirus 2 T he Severe Acute Respiratory Syndrome coronavirus 2 (SARS-CoV-2) was given pandemic status by the World Health Organization in March 2020. 1,2 When symptomatic, coronavirus disease 2019 (COVID-19) typically causes mild, self-limiting respiratory features. However, a severe lower respiratory and multisystem disease may occur, necessitating hospitalization. 3 Approximately 6.0% of patients with COVID-19 die, and 12% require intensive care support. 4-7 Symptoms alone are insufficient for a diagnosis due to a high prevalence of asymptomatic carriers and a variable presymptomatic incubation period (2-14 days). 8,9 The diagnostic reference standard is the reverse-transcriptase polymerase chain reaction