Paediatric Fever Management Practices and Antipyretic Use Among Doctors and Nurses in Australian Emergency Departments

TL;DR

Few Australian emergency department doctors and nurses follow international guidelines for treating fever in children.

Contribution

This study reveals low adherence to evidence-based fever management guidelines among Australian ED clinicians.

Findings

Only 9.3% of clinicians adhered to international best practice guidelines for pediatric fever treatment.

Specialist pediatric ED clinicians showed significantly lower adherence compared to general ED clinicians.

Over one-third of respondents recommended antipyretics for febrile convulsion prevention.

Abstract

To examine variation in practice and adherence to international clinical guidelines for the management of fever among Australian Emergency Department (ED) clinicians.

Cross‐sectional survey across 22 Australian EDs. Clinical vignettes were used to determine compliance with international best practice guidelines (use of antipyretic monotherapy to alleviate fever‐associated child distress) for paediatric fever treatment. Comparisons were made between specialist paediatric EDs and general (non‐specialist paediatric) EDs, and between medical and nursing staff.

Of 539 survey respondents (300 doctors, 239 nurses; overall response rate 65.9%), only 9.3% (50/539, 95% confidence interval [CI] 7.1%–12.0%) adhered to evidence‐based practice guidelines. Specialist paediatric ED clinicians demonstrated less than half the adherence of those from general EDs (5.4% [11/204] vs. 12.4% [38/307], difference −7.0%, 95% CI −11.7% to −1.9%). In a febrile settled child with normal hydration, the proportion of respondents who opted for antipyretics more than doubled in the context of elevated vital signs (40.4% [218/539] vs. 83.1% [44/539], difference −42.7%, 95% CI −46.8% to −38.2%). Nearly half of respondents (239/539, 46.8%, 95% CI 42.4%–51.2%) endorsed giving combined antipyretic therapy. In a febrile settled child, most participants would give antipyretics for temperature reduction (453/539, 84.0%, 95% CI 80.7%–86.9%) and for decreased fluid intake (468/539, 87.5%, 95% CI 84.4%–90.0%). Over one‐third (192/539, 36.0%, 95% CI 32.1%–40.2%) recommended using antipyretics for febrile convulsion prevention during the current illness.

Fewer than 10% of Australian ED clinicians self‐report practice consistent with international consensus recommendations for paediatric fever management.