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The Effective Management of Fever in Pediatrics and Insights on Remote Management: Experts' Consensus Using a Delphi
Elena Chiappini1, Antonio Vitale2, Raffaele Badolato3
1Pediatric Infectious Disease Unit, Anna Meyer Children's University Hospital, Florence, Italy.
Insights
Italian pediatricians reached consensus on managing fever in children, particularly regarding therapeutic appropriateness and remote care, despite some disagreements on managing febrile children with other illnesses. Their expert opinions can aid clinical decisions.
Area of Science:
- Pediatrics
- Evidence-based Medicine
- Clinical Practice Guidelines
Background:
- Italian guidelines for pediatric fever treatment updated in 2017 still leave fundamental questions unresolved.
- The COVID-19 pandemic introduced new challenges and questions regarding fever management in children.
Purpose of the Study:
- To determine the level of consensus among Italian pediatricians on key aspects of fever treatment in children.
- To utilize the Delphi technique to assess expert opinions on pediatric fever management.
Main Methods:
- A Delphi study was conducted from June to September 2021, involving two anonymous questionnaire rounds sent to pediatricians.
- 80 out of 500 invited pediatricians (16% participation rate) voluntarily joined the study.
- Questionnaires covered therapeutic appropriateness, fever management with comorbidities, and remote care strategies.
Main Results:
- High consensus (≥75%) was achieved on statements regarding therapeutic appropriateness and future remote management strategies.
- Consensus was not reached on one statement concerning the management of febrile children with co-existing diseases, even after the second round.
- A total of 75 pediatricians participated, providing valuable expert opinions.
Conclusions:
- Italian pediatricians demonstrate significant agreement on various aspects of treating febrile children.
- Expert consensus can complement existing regulatory recommendations and guidelines in clinical practice.
- Further discussion may be needed for specific scenarios involving febrile children with other diseases.
Background:
Even after the publication of the 2017 update of Italian guidelines on treatment of fever in pediatrics, some fundamental questions are still open and new ones emerged during the COVID-19 pandemic.
Objective:
To assess the level of consensus among Italian pediatricians on different topics related to treatment of fever in children by using the Delphi technique.
Methods:
A Delphi study was undertaken between June and September 2021, when two questionnaires were consecutively sent to a panel of experts to be answered anonymously. An invitation to participate was sent to 500 pediatricians distributed over the whole national territory and 80 (16%) of them accepted to participate on a voluntary basis. The questionnaires were structured into three specific topics: "therapeutic appropriateness and management of the febrile child," "management of the febrile child in the presence of other diseases," and "future perspectives in remote management." Each topic had six statements.
Results:
A first-round questionnaire was sent to 80 accepting pediatricians from different Italian regions. Of the 72 respondents (23% working in hospitals and 72% outside), 33% were from northern, 12% central, and 55% southern Italy or islands. A second-round questionnaire was sent to the same 80 pediatricians and 69 of them responded, without significant differences for workplaces or geographical distribution as compared with the first questionnaire. Overall, 75 participants answered at least one of the two questionnaires. All the statements on the topics of "therapeutic appropriateness and management of the febrile child" and "future perspectives in remote management" reached the predefined cut off for consensus (75% or more). Only one statement on "management of the febrile child in the presence of other diseases" did not achieve the consensus even after the second round.
Conclusions:
Italian pediatricians agree on several aspects of treatment of febrile children and their expert opinions could support everyday decision process complementary to recommendations by regulatory agencies and guidelines.
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