Abstract
Introduction
Divergent attitudes towards fever have led to a high level of inconsistency in approaches to its management. In an attempt to overcome this, clinical practice guidelines (CPGs) for the symptomatic management of fever in children have been produced by several healthcare organizations. To date, a comprehensive assessment of the evidence level of the recommendations made in these CPGs has not been carried out.
Methods
Searches were conducted on Pubmed, google scholar, pediatric society websites and guideline databases to locate CPGs from each country (with date coverage from January 1995 to September 2020). Rather than assessing overall guideline quality, the level of evidence for each recommendation was evaluated according to criteria of the Oxford Centre for Evidence-Based Medicine (OCEBM). A GRADE assessment was undertaken to assess the body of evidence related to a single question: the threshold for initiating antipyresis. Methods and results are reported according to the PRISMA statement.
Results
74 guidelines were retrieved. Recommendations for antipyretic threshold, type and dose; ambient temperature; dress/covering; activity; fluids; nutrition; proctoclysis; external applications; complementary/herbal recommendations; media; and age-related treatment differences all varied widely. OCEBM evidence levels for most recommendations were low (Level 3–4) or indeterminable. The GRADE assessment revealed a very low level of evidence for a threshold for antipyresis.
Conclusion
There is no recommendation on which all guidelines agree, and many are inconsistent with the evidence–this is true even for recent guidelines. The threshold question is of fundamental importance and has not yet been answered. Guidelines for the most frequent intervention (antipyresis) remain problematic.
Funder
Federal Ministry of Education and Research
Software AG – Foundation
University of Witten/Herdecke
Publisher
Public Library of Science (PLoS)
Reference185 articles.
1. Why are fever temperatures over 106 degrees F. rare?;EF DuBOIS;Am J Med Sci,1949
2. Parental and health care provider understanding of childhood fever: a Canadian perspective;A Karwowska;CJEM,2002
3. Fever phobia revisited: have parental misconceptions about fever changed in 20 years?;M Crocetti;Pediatrics,2001
4. Fever Phobia as a Reason for Pediatric Emergency Department Visits: Does the Primary Care Physician Make a Difference?;E Elkon-Tamir;Rambam Maimonides Med J,2017
5. Fever phobia: The impact of time and mortality—a systematic review and meta-analysis;E Purssell;Int J Nurs Stud,2016
Cited by
20 articles.
订阅此论文施引文献
订阅此论文施引文献,注册后可以免费订阅5篇论文的施引文献,订阅后可以查看论文全部施引文献