When fever, paracetamol? Theory and practice in a paediatric outpatient clinic.
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.


METHODS
Paediatric Emergency Department.


METHODS
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.


METHODS
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.


CONCLUSIONS
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.
Gehri
Mario
M
Hôpital de l'Enfance de Lausanne, ch. de Montétan 16, 1000, Lausanne 7, Switzerland. Mario.Gehri@chuv.hospvd.ch
Guignard
Emmanuèle
E
Djahnine
Samira Radji
SR
Cotting
Jocelyne Quillet
JQ
Yersin
Corinne
C
Di Paolo
Ermindo R
ER
Krahenbuhl
Jean-Daniel
JD
Pannatier
André
A
D000082:Acetaminophen / Q000627:therapeutic use*; D018712:Analgesics, Non-Narcotic / Q000627:therapeutic use; D001831:Body Temperature; D001835:Body Weight; D002675:Child, Preschool; D003625:Data Collection; D005260:Female; D005334:Fever / Q000175:diagnosis / Q000188:drug therapy*; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007223:Infant; D008297:Male; D009726:Nurses; D010044:Outpatient Clinics, Hospital; D010820:Physicians; D011446:Prospective Studies; D011795:Surveys and Questionnaires
D018712:Analgesics, Non-Narcotic; D000082:Acetaminophen