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When fever, paracetamol? Theory and practice in a paediatric outpatient clinic
Mario Gehri1, Emmanuèle Guignard, Samira Radji Djahnine
1Hôpital de l'Enfance de Lausanne, ch. de Montétan 16, 1000, Lausanne 7, Switzerland. Mario.Gehri@chuv.hospvd.ch
Insights
Medical and nursing staff generally manage feverish children correctly, but under-treatment and incorrect dosing of antipyretics are common. Addressing staff knowledge gaps can help reduce parental fever phobia.
Area of Science:
- Pediatrics
- Emergency Medicine
- Clinical Pharmacy
Background:
- Fever is a common symptom in children, often leading to parental anxiety and potential over-treatment.
- Understanding healthcare professionals' management of fever is crucial for improving child health outcomes and parental education.
Purpose of the Study:
- To assess how medical and nursing staff manage feverish children in a pediatric emergency setting.
- To compare clinical practice with theoretical knowledge of fever management.
- To evaluate the contribution of staff practices to parental fever phobia.
Main Methods:
- Prospective analysis of 114 children's medical files in a Pediatric Emergency Department.
- Evaluation of doctors' and nurses' knowledge and perceptions of fever via questionnaire.
- Assessment of fever definition, measurement, clinical evaluation, and antipyretic drug choice.
Main Results:
- Staff demonstrated good theoretical knowledge but also an excessive fear of cerebral damage, potentially fueling parental fever phobia.
- Fever was often under-treated, with insufficient paracetamol dosing and underutilization of NSAIDs.
- Rectal administration and physical methods like sponging were frequently used, despite evidence limitations.
Conclusions:
- While overall management in the Pediatric Emergency Department was deemed correct, specific improvements are needed.
- Recommendations include standardized temperature ranges, measurement techniques, antipyretic dosing, and parental guidelines.
- Implementation of pharmaceutical follow-up is justified to enhance fever management protocols.
Objective:
To determine how medical and nursing staff treat feverish children and compare the findings with their theoretical knowledge, evaluating how they might contribute to fever phobia in parents.
Setting:
Paediatric Emergency Department.
Method:
In the first step, we analysed prospectively the files of all children having consulted the Paediatric Emergency Department with a history of fever or of body temperature above 38 degrees C during a 2-week period. The second step consisted of evaluating knowledge and perception of fever of doctors and nurses using a questionnaire.
Main Outcome Measures:
Prospective study: final diagnosis (viral, non- invasive bacterial disorders, invasive bacterial disorders), site of measurement and average temperature. Evaluation of theoretical knowledge: definition of fever, site of measurement, evaluation of the child's clinical state, antipyretic drug choice.
Results:
A total of 114 children under 5 years of age were enrolled and 24 caregivers (12 doctors, 12 nurses, 90 of the staff) responded to the questionnaire. The results showed good consistency in theoretical knowledge, but an excessive fear about cerebral damage was also shown by doctors. This belief likely contributes to the transmission of fever phobia to parents. In contrast, analysis of children management showed that fever was often under-treated, especially by nurses and even more so by parents. Paracetamol remained the first-line antipyretic drug yet was often administered in insufficient doses. Non-steroidal anti-inflammatory drugs were seldom used, except by parents (16 of all the children). Contrary to literature, the favourite route of administration was the rectal one. Physical methods like sponging were largely used by nurses, despite the uncertainties in their real effectiveness and their known side-effects.
Conclusion:
Our study showed that the management of feverish children was globally correct in the Paediatric Emergency Department, but several improvement measures have been taken (e.g. tables of normal and abnormal ranges of temperature, recommended temperature measurement techniques, dosage regimen of antipyretic drugs, guidelines to parents), justifying the implementation of a pharmaceutical follow-up.
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