title: Attitudes towards fever amongst UK paediatric intensive care staff.
abstract: The role played by fever in the outcome of critical illness in children is unclear. This survey of medical and nursing staff in 35 paediatric intensive care units and transport teams in the United Kingdom and Ireland established attitudes towards the management of children with fever. Four hundred sixty-two medical and nursing staff responded to a web-based survey request. Respondents answered eight questions regarding thresholds for temperature control in usual clinical practice, indications for paracetamol use, and readiness to participate in a clinical trial of permissive temperature control. The median reported threshold for treating fever in clinical practice was 38 °C (IQR 38-38.5 °C). Paracetamol was reported to be used as an analgesic and antipyretic but also for non-specific comfort indications. There was a widespread support for a clinical trial of a permissive versus a conservative approach to fever in paediatric intensive care units. Within a trial, 58% of the respondents considered a temperature of 39 °C acceptable without treatment.
  
  
  CONCLUSIONS
  Staff on paediatric intensive care units in the United Kingdom and Ireland tends to treat temperatures within the febrile range. There was a willingness to conduct a randomized controlled trial of treatment of fever. What is known: • The effect of fever on the outcome in paediatric critical illness is unknown. • Paediatricians have traditionally been reluctant to allow fever in sick children. What is new: • Paediatric intensive care staff report a tendency towards treating fever, with a median reported treatment threshold of 38 °C. • There is widespread support amongst PICU staff in the UK for a randomized controlled trial of temperature in critically ill children. • Within a trial setting, PICU staff attitudes to fever are more permissive than in clinical practice.
authors.affiliation: Paediatric Intensive Care Unit, Great Ormond Street Hospital NHS Foundation Trust, London, UK. thomas.brick@gmail.com.
authors.forename: Thomas
authors.identifier: http://orcid.org/0000-0002-2806-0000
authors.initials: T
authors.lastname: Brick
authors.affiliation: Paediatric Intensive Care Unit, Great North Children's Hospital, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Institute of Cellular Medicine, Newcastle University, Newcastle, UK.
authors.forename: Rachel S
authors.initials: RS
authors.lastname: Agbeko
authors.affiliation: Paediatric Intensive Care Unit, Nottingham Children's Hospital, Nottingham University Hospitals NHS Trust, Nottingham, UK.
authors.forename: Patrick
authors.initials: P
authors.lastname: Davies
authors.affiliation: Paediatric Intensive Care Unit, Bristol Royal Hospital for Children, University Hospitals Bristol NHS Foundation Trust, Bristol, UK.
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Davis
authors.affiliation: Paediatric Intensive Care Unit, King's College Hospital NHS Foundation Trust, London, UK.
authors.forename: Akash
authors.initials: A
authors.lastname: Deep
authors.affiliation: Paediatric Intensive Care Unit, Royal Manchester Children's Hospital, Central Manchester University Hospitals NHS Foundation Trust, Manchester, UK.
authors.forename: Peter-Marc
authors.initials: PM
authors.lastname: Fortune
authors.affiliation: Paediatric Intensive Care Unit, St Mary's Hospital, Imperial College Healthcare NHS Trust, London, UK.
authors.forename: David P
authors.initials: DP
authors.lastname: Inwald
authors.affiliation: Paediatric Intensive Care Unit, Great Ormond Street Hospital NHS Foundation Trust, London, UK.
authors.forename: Amy
authors.initials: A
authors.lastname: Jones
authors.affiliation: Paediatric Intensive Care Unit, Royal Hospital for Children, Glasgow, UK.
authors.forename: Richard
authors.initials: R
authors.lastname: Levin
authors.affiliation: Paediatric Intensive Care Unit, Birmingham Children's Hospital NHS Foundation Trust, Birmingham, UK.
authors.forename: Kevin P
authors.initials: KP
authors.lastname: Morris
authors.affiliation: Paediatric Intensive Care Unit, University Hospital Southampton NHS Foundation Trust, Southampton, UK.
authors.forename: John
authors.initials: J
authors.lastname: Pappachan
authors.affiliation: Respiratory, Critical Care and Anaesthesia Unit, University College London Institute of Child Health, London, UK.
authors.forename: Samiran
authors.initials: S
authors.lastname: Ray
authors.affiliation: Paediatric Intensive Care Unit, Evelina Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK.
authors.forename: Shane M
authors.initials: SM
authors.lastname: Tibby
authors.affiliation: School of Health, University of Central Lancashire, Lancashire, UK.
authors.forename: Lyvonne N
authors.initials: LN
authors.lastname: Tume
authors.affiliation: Paediatric Intensive Care Unit, Great Ormond Street Hospital NHS Foundation Trust, London, UK.|Respiratory, Critical Care and Anaesthesia Unit, University College London Institute of Child Health, London, UK.
authors.forename: Mark J
authors.initials: MJ
authors.lastname: Peters
mesh_terms: D000082:Acetaminophen / Q000627:therapeutic use*; D058633:Antipyretics / Q000627:therapeutic use*; D001291:Attitude of Health Personnel; D002648:Child; D003430:Cross-Sectional Studies; D005334:Fever / Q000628:therapy*; D006801:Humans; D015278:Intensive Care Units, Pediatric; D007494:Ireland; D016032:Randomized Controlled Trials as Topic; D011795:Surveys and Questionnaires; D006113:United Kingdom
chemical_list: D058633:Antipyretics; D000082:Acetaminophen
keywords: Acetaminophen; Attitudes to fever; Fever; Medical practises; Nursing practises; Paediatric intensive care; Paracetamol