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Underdosing of acetaminophen by parents and emergency department utilization
Ran D Goldman1, Dennis Scolnik
1Pediatric Research in Emergency Therapeutics Program (PRETx), Division of Pediatric Emergency Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada; Department of Paediatrics, University of Toronto, Toronto, Ontario, Canada.
Insights
Many parents underdose acetaminophen for children's fever, indicating a need for better education. If fever had subsided with medication, most parents would not have visited the emergency department.
Area of Science:
- Pediatrics
- Pharmacology
- Public Health
Background:
- Fever is a frequent pediatric concern prompting medical visits.
- Accurate administration of fever-reducing medication is crucial for effective home management.
Purpose of the Study:
- To assess the accuracy of parental acetaminophen dosing for pediatric fever.
- To determine if successful fever reduction at home would alter emergency department (ED) visit decisions.
Main Methods:
- Cross-sectional study involving 248 caregivers of children with fever treated with acetaminophen.
- Interviews were conducted to gather data on medication administration and parental decisions.
Main Results:
- 47% of parents administered the recommended acetaminophen dose; 12% overdosed, and 41% underdosed.
- 54% of parents reported they would not have visited the ED if fever had subsided.
- Higher initial fever temperatures correlated with ED visits, even if fever later subsided.
Conclusions:
- Underdosing of acetaminophen is common, suggesting knowledge gaps or misuse.
- Many ED visits for pediatric fever may be preventable if home treatment effectively reduces temperature.
- Factors beyond incorrect acetaminophen dosing likely influence parental decisions to seek emergency care.
Objectives:
Fever is a common reason for parents to seek medical attention for their children. We conducted this study to document accuracy of parental administration of acetaminophen and to identify if parents who did not give an optimal dose would have decided not to come to the emergency department (ED) if the fever had diminished at home.
Methods:
A cross-sectional study including 248 caregivers of children who had a chief complaint of fever and had been given acetaminophen in the preceding 24 hours were interviewed.
Results:
Enrollment was 86%. One hundred parents (47%) gave acetaminophen in the recommended dose, 26 parents (12%) gave an overdose, and 87 (41%) gave an underdose of acetaminophen. Half of the parents (54%) would not have come to the ED if the fever had subsided after using the antipyretic treatment at home. Children with significantly higher maximal temperature at home would not have been taken to the ED if fever had subsided. Parents who speak English as the primary language at home gave the recommended dose of acetaminophen more frequently than non-English-speaking parents.
Conclusion:
A significant portion of our population gives an underdose of acetaminophen, reflecting lack of knowledge or misuse. Based on parental reports, the majority of visits for fever might have been prevented, if parents had been successful in their effort to reduce temperature to below of what they considered as fever, but factors other than underdosing of acetaminophen probably encourage parents of febrile children to visit the ED.
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