Methodological Quality and Content Analysis of Clinical Practice Guidelines for Fever Management in Children With...

Infection/sepsis remains the number one cause of death among children under the age of 5 with sickle cell disease (SCD). Although clinical practice guidelines (CPGs) are an important tool for standardizing evidence-based care, the quantity and quality of existing CPGs for managing acute fever in children with SCD is unknown. We conducted a systematic review of CPGs published in the last 10 years addressing acute fever management in children with SCD. A PubMed search was conducted using standard search filters for CPGs, pediatrics, fever, and SCD. Additionally, a manual search of article citations, professional societies and consortia websites, and inquiries with experts was performed. CPGs were appraised by two reviewers using the Appraisal of Guidelines for Research and Evaluation II (AGREE II) instrument [http://www.agreetrust.org]. Results are summarized using descriptive statistics. The systematic and manual searches yielded 839 articles; 8 CPGs met inclusion criteria, but none were dedicated SCD acute fever CPGs. Geographic representation included France, India, Italy, Nigeria, sub-Saharan Africa, the United Kingdom, and the United States. The mean overall quality score was 46% (range 25%-67%). Rigorously developed CPGs focused on managing acute fever in children with SCD are lacking. This work highlights the need to generate a high-quality evidence-based CPG for managing acute fever in pediatric SCD.