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An exploration into registered nurses' knowledge of adult fever in Scotland: A mixed method study. Nurse Educ Pract 2022; 63:103411. [PMID: 35868061 DOI: 10.1016/j.nepr.2022.103411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 06/28/2022] [Accepted: 07/11/2022] [Indexed: 11/20/2022]
Abstract
BACKGROUND Fever may be a result of many causes, infective or non-infective. Nurses' fever management can be affected by their knowledge and beliefs and also by patients' beliefs. Consequently, an understanding of fever is vital in the diagnosis, treatment and follow-up of various ailments and diseases. Greater knowledge of fever will guide more accurate assessments of the epidemiology of fever and its management. OBJECTIVES This study explored nurses' knowledge in the context of fever and identified factors that affected this knowledge acquisition. METHODS A mixed methods approach was used with a validated questionnaire designed to gather information about nurses' knowledge of fever. This was followed up by semi-structured interviews to explore factors associated with the acquisition of fever knowledge. The online survey was distributed to registered nurses in Scotland. RESULTS A total of 177 questionnaires were completed. The questionnaires were scored with a correct answer 1 point, while a wrong answer -1 point. The mean total score in the knowledge section was 0.47. Only 49.2 % of participants scored above 0. The stepwise linear regression demonstrated working experience in critical care unit, acute care unit and the role of nurse practitioner together could predict 10 % of the total knowledge score (P < 0.05). Through analysis of associations and qualitative data, it was found that many factors had contributed to the nurses' knowledge about fever, specifically educational content, individual confidence and the Sepsis Six bundle. CONCLUSIONS Considerable misconceptions were found to exist in the nurses' understanding of fever. Only a few factors were found to be associated with the total knowledge score. It was highlighted that the due to the strong influence of the Sepsis Six bundle, participants often assumed a direct causal connection between fever and infectious disease or sepsis. The study result indicated a concern in nurses' acquisition of fever knowledge. TWEETABLE ABSTRACT Misconceptions from foundational learning were found in nurses' understanding of fever. However, the Sepsis 6 was found to impact their current knowledge of fever.
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Rationalization of the Laboratory Diagnosis for Good Management of Malaria: Lessons from Transitional Methods. J Trop Med 2022; 2022:5883173. [PMID: 35502242 PMCID: PMC9056208 DOI: 10.1155/2022/5883173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 12/27/2021] [Accepted: 04/09/2022] [Indexed: 11/28/2022] Open
Abstract
Introduction Malaria is an endemic disease in sub-Saharan Africa. In clinical practice, the main concern is the overdiagnosis of malaria leading to inappropriate drug prescription without laboratory confirmation. Objective This study aimed to evaluate clinical examination reliability compared with translational laboratory methods of malaria diagnosis. Methods The study was conducted in Goundi Hospital among hospitalized patients over a seven-month period. Patients were interviewed, and malaria tests done included the Giemsa-stained thick and thin blood smears. Diagnostic accuracy was analysed by calculating sensitivity, specificity, and predictive values. Results Among 1,874 participants, 674 (35.96%) patients had positive Giemsa-stained thick blood films. The rate of positivity is higher for patients under 5 years of age. The parasite densities were between 160 and 84.000 parasites/μL. The threshold pyrogen of the parasitic density was around 10.000 parasites/μL for patients between 0 and 11 months of age, between 1 and 4 years of age, and between 5 and 14 years of age. This threshold was lower for patients over 15 years of age. The study reported some issues in the findings: 60.88% (607/997) cases of fever without positivity of the blood thick smear and 40.13% (284/674) cases of positivity of the thick drop without fever. The positive predictive value of malaria was between 80 and 85% for patients under 5 years of age. This value is lower for patients between 5 and 14 years of age and patients over 15 years of age. Conclusion A presumptive diagnosis of malaria should be confirmed by the laboratory in all suspected cases in all possible scenarios. Every parasitemia should be followed by the calculation of parasitic density. However, for the children under 5 years of age in areas of high transmission, the presumptive diagnosis of malaria in certain circumstances could be considered.
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Green C, Krafft H, Guyatt G, Martin D. Symptomatic fever management in children: A systematic review of national and international guidelines. PLoS One 2021; 16:e0245815. [PMID: 34138848 PMCID: PMC8211223 DOI: 10.1371/journal.pone.0245815] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Accepted: 05/19/2021] [Indexed: 01/08/2023] Open
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.
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Affiliation(s)
- Cari Green
- Gerhard Kienle Chair, Health Department, University of Witten/Herdecke, Herdecke, Germany
| | - Hanno Krafft
- Gerhard Kienle Chair, Health Department, University of Witten/Herdecke, Herdecke, Germany
| | - Gordon Guyatt
- Departments of Health Research Methods, Evidence and Impact and Medicine at McMaster University, Hamilton, Canada
| | - David Martin
- Gerhard Kienle Chair, Health Department, University of Witten/Herdecke, Herdecke, Germany
- University Children’s Hospital, Tübingen University, Tübingen, Germany
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Deja E, Peters MJ, Khan I, Mouncey PR, Agbeko R, Fenn B, Watkins J, Ramnarayan P, Tibby SM, Thorburn K, Tume LN, Rowan KM, Woolfall K. Establishing and augmenting views on the acceptability of a paediatric critical care randomised controlled trial (the FEVER trial): a mixed methods study. BMJ Open 2021; 11:e041952. [PMID: 33692177 PMCID: PMC7949453 DOI: 10.1136/bmjopen-2020-041952] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2020] [Revised: 02/02/2021] [Accepted: 02/10/2021] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVE To explore parent and staff views on the acceptability of a randomised controlled trial investigating temperature thresholds for antipyretic intervention in critically ill children with fever and infection (the FEVER trial) during a multi-phase pilot study. DESIGN Mixed methods study with data collected at three time points: (1) before, (2) during and (3) after a pilot trial. SETTING English, Paediatric Intensive Care Units (PICUs). PARTICIPANTS (1) Pre-pilot trial focus groups with pilot site staff (n=56) and interviews with parents (n=25) whose child had been admitted to PICU in the last 3 years with a fever and suspected infection, (2) Questionnaires with parents of randomised children following pilot trial recruitment (n=48 from 47 families) and (3) post-pilot trial interviews with parents (n=19), focus groups (n=50) and a survey (n=48) with site staff. Analysis drew on Sekhon et al's theoretical framework of acceptability. RESULTS There was initial support for the trial, yet some held concerns regarding the proposed temperature thresholds and not using paracetamol for pain or discomfort. Pre-trial findings informed protocol changes and training, which influenced views on trial acceptability. Staff trained by the FEVER team found the trial more acceptable than those trained by colleagues. Parents and staff found the trial acceptable. Some concerns about pain or discomfort during weaning from ventilation remained. CONCLUSIONS Pre-trial findings and pilot trial experience influenced acceptability, providing insight into how challenges may be overcome. We present an adapted theoretical framework of acceptability to inform future trial feasibility studies. TRIAL REGISTRATION NUMBERS ISRCTN16022198 and NCT03028818.
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Affiliation(s)
- Elizabeth Deja
- Public Health, Policy and Systems, University of Liverpool, Liverpool, UK
| | - Mark J Peters
- Paediatric Intensive Care Unit, Great Ormond Street Hospital for Children NHS Trust, London, UK
- Infection, Immunity and Inflammation, Institute of Child Health, University College London, London, UK
| | - Imran Khan
- Institute of Population Health Sciences, Queen Mary University of London, London, UK
| | - Paul R Mouncey
- Clinical Trials Unit, Intensive Care National Audit and Research Centre, London, UK
| | - Rachel Agbeko
- Paediatric Intensive Care Unit, Great North Children's Hospital, Newcastle Upon Tyne, UK
| | | | | | - Padmanabhan Ramnarayan
- Children's Acute Transport Service, Great Ormond Street Hospital for Children, London, UK
| | - Shane M Tibby
- Paediatric Intensive Care Unit, Evelina London Children's Hospital, London, UK
| | - Kentigern Thorburn
- Paediatric Intensive Care Unit, Alder Hey Children's Hospital, Liverpool, UK
| | - Lyvonne N Tume
- School of Health and Society, University of Salford, Salford, UK
| | - Kathryn M Rowan
- Intensive Care National Audit and Research Centre, London, UK
| | - Kerry Woolfall
- Public Health, Policy and Systems, University of Liverpool, Liverpool, UK
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Peters MJ, Khan I, Woolfall K, Deja E, Mouncey PR, Wulff J, Mason A, Agbeko R, Draper ES, Fenn B, Gould DW, Koelewyn A, Klein N, Mackerness C, Martin S, O'Neill L, Ramnarayan P, Tibby S, Tume L, Watkins J, Thorburn K, Wellman P, Harrison DA, Rowan KM. Different temperature thresholds for antipyretic intervention in critically ill children with fever due to infection: the FEVER feasibility RCT. Health Technol Assess 2020; 23:1-148. [PMID: 30793698 DOI: 10.3310/hta23050] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Fever accelerates host immune system control of pathogens but at a high metabolic cost. The optimal approach to fever management and the optimal temperature thresholds used for treatment in critically ill children are unknown. OBJECTIVES To determine the feasibility of conducting a definitive randomised controlled trial (RCT) to evaluate the clinical effectiveness and cost-effectiveness of different temperature thresholds for antipyretic management. DESIGN A mixed-methods feasibility study comprising three linked studies - (1) a qualitative study exploring parent and clinician views, (2) an observational study of the epidemiology of fever in children with infection in paediatric intensive care units (PICUs) and (3) a pilot RCT with an integrated-perspectives study. SETTING Participants were recruited from (1) four hospitals in England via social media (for the FEVER qualitative study), (2) 22 PICUs in the UK (for the FEVER observational study) and (3) four PICUs in England (for the FEVER pilot RCT). PARTICIPANTS (1) Parents of children with relevant experience were recruited to the FEVER qualitative study, (2) patients who were unplanned admissions to PICUs were recruited to the FEVER observational study and (3) children admitted with infection requiring mechanical ventilation were recruited to the FEVER pilot RCT. Parents of children and clinicians involved in the pilot RCT. INTERVENTIONS The FEVER qualitative study and the FEVER observational study had no interventions. In the FEVER pilot RCT, children were randomly allocated (1 : 1) using research without prior consent (RWPC) to permissive (39.5 °C) or restrictive (37.5 °C) temperature thresholds for antipyretics during their PICU stay while mechanically ventilated. MAIN OUTCOME MEASURES (1) The acceptability of FEVER, RWPC and potential outcomes (in the FEVER qualitative study), (2) the size of the potentially eligible population and the temperature thresholds used (in the FEVER observational study) and (3) recruitment and retention rates, protocol adherence and separation between groups and distribution of potential outcomes (in the FEVER pilot RCT). RESULTS In the FEVER qualitative study, 25 parents were interviewed and 56 clinicians took part in focus groups. Both the parents and the clinicians found the study acceptable. Clinicians raised concerns regarding temperature thresholds and not using paracetamol for pain/discomfort. In the FEVER observational study, 1853 children with unplanned admissions and infection were admitted to 22 PICUs between March and August 2017. The recruitment rate was 10.9 per site per month. The majority of critically ill children with a maximum temperature of > 37.5 °C received antipyretics. In the FEVER pilot RCT, 100 eligible patients were randomised between September and December 2017 at a recruitment rate of 11.1 per site per month. Consent was provided for 49 out of 51 participants in the restrictive temperature group, but only for 38 out of 49 participants in the permissive temperature group. A separation of 0.5 °C (95% confidence interval 0.2 °C to 0.8 °C) between groups was achieved. A high completeness of outcome measures was achieved. Sixty parents of 57 children took part in interviews and/or completed questionnaires and 98 clinicians took part in focus groups or completed a survey. Parents and clinicians found the pilot RCT and RWPC acceptable. Concerns about children being in pain/discomfort were cited as reasons for withdrawal and non-consent by parents and non-adherence to the protocol by clinicians. LIMITATIONS Different recruitment periods for observational and pilot studies may not fully reflect the population that is eligible for a definitive RCT. CONCLUSIONS The results identified barriers to delivering the definitive FEVER RCT, including acceptability of the permissive temperature threshold. The findings also provided insight into how these barriers may be overcome, such as by limiting the patient inclusion criteria to invasive ventilation only and by improved site training. A definitive FEVER RCT using a modified protocol should be conducted, but further work is required to agree important outcome measures for clinical trials among critically ill children. TRIAL REGISTRATION The FEVER observational study is registered as NCT03028818 and the FEVER pilot RCT is registered as Current Controlled Trials ISRCTN16022198. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 23, No. 5. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Mark J Peters
- Respiratory, Critical Care and Anaesthesia Unit, University College London Great Ormond Street Institute of Child Health, London, UK
| | - Imran Khan
- Clinical Trials Unit, Intensive Care National Audit and Research Centre, London, UK
| | - Kerry Woolfall
- Department of Psychological Sciences, North West Hub for Trials Methodology, University of Liverpool, Liverpool, UK
| | - Elizabeth Deja
- Department of Psychological Sciences, North West Hub for Trials Methodology, University of Liverpool, Liverpool, UK
| | - Paul R Mouncey
- Clinical Trials Unit, Intensive Care National Audit and Research Centre, London, UK
| | - Jerome Wulff
- Clinical Trials Unit, Intensive Care National Audit and Research Centre, London, UK
| | - Alexina Mason
- Clinical Trials Unit, Intensive Care National Audit and Research Centre, London, UK
| | - Rachel Agbeko
- Paediatric Intensive Care Unit, Great North Children's Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | | | | | - Doug W Gould
- Clinical Trials Unit, Intensive Care National Audit and Research Centre, London, UK
| | - Abby Koelewyn
- Clinical Trials Unit, Intensive Care National Audit and Research Centre, London, UK
| | - Nigel Klein
- Institute of Child Health, University College London, London, UK
| | - Christine Mackerness
- Paediatric Intensive Care Unit, Great North Children's Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Sian Martin
- Clinical Trials Unit, Intensive Care National Audit and Research Centre, London, UK
| | - Lauran O'Neill
- Respiratory, Critical Care and Anaesthesia Unit, University College London Great Ormond Street Institute of Child Health, London, UK
| | | | - Shane Tibby
- Evelina London Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Lyvonne Tume
- Faculty of Health and Applied Sciences, University of the West of England, Bristol, UK
| | | | - Kent Thorburn
- Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | - Paul Wellman
- Evelina London Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - David A Harrison
- Clinical Trials Unit, Intensive Care National Audit and Research Centre, London, UK
| | - Kathryn M Rowan
- Clinical Trials Unit, Intensive Care National Audit and Research Centre, London, UK
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Ludwig J, McWhinnie H. Antipyretic drugs in patients with fever and infection: literature review. ACTA ACUST UNITED AC 2019; 28:610-618. [PMID: 31116598 DOI: 10.12968/bjon.2019.28.10.610] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND antipyretic drugs are routinely administered to febrile patients with infection in secondary care. However, the use of antipyretics to suppress fever during infection remains a controversial topic within the literature. It is argued that fever suppression may interfere with the body's natural defence mechanisms, and may worsen patient outcomes. METHOD a literature review was undertaken to determine whether the administration of antipyretic drugs to adult patients with infection and fever, in secondary care, improves or worsens patient outcomes. RESULTS contrasting results were reported; two studies demonstrated improved patient outcomes following antipyretic administration, while several studies demonstrated increased mortality risk associated with antipyretics and/or demonstrated fever's benefits during infection. Results also demonstrated that health professionals continue to view fever as deleterious. CONCLUSION the evidence does not currently support routine antipyretic administration. Considering patients' comorbidities and symptoms of their underlying illness will promote safe, evidence-based and appropriate administration of antipyretics.
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Affiliation(s)
| | - Hazel McWhinnie
- Senior Lecturer, Health and Community Services, Education Department, Government of Jersey
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Performance of axillary and rectal temperature measurement in private pediatric practice. Eur J Pediatr 2019; 178:1501-1505. [PMID: 31396691 DOI: 10.1007/s00431-019-03438-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2019] [Revised: 07/11/2019] [Accepted: 07/29/2019] [Indexed: 10/26/2022]
Abstract
To better understand the role and reliability of axillary temperature measurements in clinical real life, axillary and rectal measurements in infants presenting in a private pediatric practice because of fever were compared. Prospectively, 169 infants (81 girls), median 9 (interquartile range 6-13) months of age, were examined at room temperature (20-24 °C). Two left and two right axillary, as well as two rectal measurements were taken with a digital thermometer and subsequently averaged. The median and interquartile range for axillary and rectal measurements were 36.9 (36.3-37.6) °C and 38.2 (37.4-38.9) °C, respectively (p < 0.0001). The limits of agreement in the Bland-Altman plots were 0.32 to 1.98 °C, with a mean bias of 1.15 °C. Axillary thermometers showed a good sensitivity for detecting rectal temperature > 38 °C (95%) but limited specificity (75%), with an area-under-the-curve of 0.95.Conclusions: Axillary readings are always lower than rectal ones, the limits of agreement are quite wide. Axillary readings can be used for screening but critical measurements should be confirmed by more reliable methods. What is Known • In infants and toddlers, temperature has been traditionally taken rectally. • Axillary measurements are better accepted and are recommended in current guidelines. What is New • Axillary temperature was always lower than rectal temperature. • The limits of agreement of axillary thermometers are wide. • Axillary thermometers have a good sensitivity but limited specificity and are therefore adequate for fever screening.
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Peters MJ, Woolfall K, Khan I, Deja E, Mouncey PR, Wulff J, Mason A, Agbeko RS, Draper ES, Fenn B, Gould DW, Koelewyn A, Klein N, Mackerness C, Martin S, O'Neill L, Ray S, Ramnarayan P, Tibby S, Thorburn K, Tume L, Watkins J, Wellman P, Harrison DA, Rowan KM. Permissive versus restrictive temperature thresholds in critically ill children with fever and infection: a multicentre randomized clinical pilot trial. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2019; 23:69. [PMID: 30845977 PMCID: PMC6407208 DOI: 10.1186/s13054-019-2354-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Accepted: 02/10/2019] [Indexed: 12/14/2022]
Abstract
Background Fever improves pathogen control at a significant metabolic cost. No randomized clinical trials (RCT) have compared fever treatment thresholds in critically ill children. We performed a pilot RCT to determine whether a definitive trial of a permissive approach to fever in comparison to current restrictive practice is feasible in critically ill children with suspected infection. Methods An open, parallel-group pilot RCT with embedded mixed methods perspectives study in four UK paediatric intensive care units (PICUs) and associated retrieval services. Participants were emergency PICU admissions aged > 28 days to < 16 years receiving respiratory support and supplemental oxygen. Subjects were randomly assigned to permissive (antipyretic interventions only at ≥ 39.5 °C) or restrictive groups (antipyretic interventions at ≥ 37.5 °C) whilst on respiratory support. Parents were invited to complete a questionnaire or take part in an interview. Focus groups were conducted with staff at each unit. Outcomes were measures of feasibility: recruitment rate, protocol adherence and acceptability, between group separation of temperature and safety. Results One hundred thirty-eight children met eligibility criteria of whom 100 (72%) were randomized (11.1 patients per month per site) without prior consent (RWPC). Consent to continue in the trial was obtained in 87 cases (87%). The mean maximum temperature (95% confidence interval) over the first 48 h was 38.4 °C (38.2–38.6) in the restrictive group and 38.8 °C (38.6–39.1) in the permissive group, a mean difference of 0.5 °C (0.2–0.8). Protocol deviations were observed in 6.8% (99/1438) of 6-h time periods and largely related to patient comfort in the recovery phase. Length of stay, duration of organ support and mortality were similar between groups. No pre-specified serious adverse events occurred. Staff (n = 48) and parents (n = 60) were supportive of the trial, including RWPC. Suggestions were made to only include invasively ventilated children for the duration of intubation. Conclusion Uncertainty around the optimal fever threshold for antipyretic intervention is relevant to many emergency PICU admissions. A more permissive approach was associated with a modest increase in mean maximum temperature. A definitive trial should focus on the most seriously ill cases in whom antipyretics are rarely used for their analgesic effects alone. Trial registration ISRCTN16022198. Registered on 14 August 2017. Electronic supplementary material The online version of this article (10.1186/s13054-019-2354-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Mark J Peters
- Respiratory, Critical Care and Anaesthesia Unit, Paediatric Intensive Care, UCL Great Ormond Street Institute of Child Health, 30 Guildford Street, London, WC1N 1EH, UK. .,Paediatric Intensive Care Unit, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK.
| | - Kerry Woolfall
- Department of Psychological Sciences, North West Hub for Trials Methodology, University of Liverpool, Liverpool, UK
| | - Imran Khan
- Clinical Trials Unit, Intensive Care National Audit and Research Centre, London, UK
| | - Elisabeth Deja
- Department of Psychological Sciences, North West Hub for Trials Methodology, University of Liverpool, Liverpool, UK
| | - Paul R Mouncey
- Clinical Trials Unit, Intensive Care National Audit and Research Centre, London, UK
| | - Jerome Wulff
- Clinical Trials Unit, Intensive Care National Audit and Research Centre, London, UK
| | - Alexina Mason
- Clinical Trials Unit, Intensive Care National Audit and Research Centre, London, UK
| | - Rachel S Agbeko
- NHS Foundation Trust, Newcastle, UK.,Institute of Cellular Medicine, Newcastle University, Newcastle, UK
| | | | - Blaise Fenn
- Patient and Parent representative, London, UK
| | - Doug W Gould
- Clinical Trials Unit, Intensive Care National Audit and Research Centre, London, UK
| | - Abby Koelewyn
- Clinical Trials Unit, Intensive Care National Audit and Research Centre, London, UK
| | - Nigel Klein
- Infection, Inflammation and Rheumatology, UCL Great Ormond Street Institute of Child Health, London, UK
| | | | - Sian Martin
- Clinical Trials Unit, Intensive Care National Audit and Research Centre, London, UK
| | - Lauran O'Neill
- Paediatric Intensive Care Unit, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Samiran Ray
- Respiratory, Critical Care and Anaesthesia Unit, Paediatric Intensive Care, UCL Great Ormond Street Institute of Child Health, 30 Guildford Street, London, WC1N 1EH, UK.,Paediatric Intensive Care Unit, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Padmanabhan Ramnarayan
- Respiratory, Critical Care and Anaesthesia Unit, Paediatric Intensive Care, UCL Great Ormond Street Institute of Child Health, 30 Guildford Street, London, WC1N 1EH, UK.,Children's Acute Transport Service, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Shane Tibby
- Evelina Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | | | - Lyvonne Tume
- Faculty of Health and Applied Sciences, University of the West of England, Glenside Campus, Bristol, UK
| | - Jason Watkins
- Institute of Cellular Medicine, Newcastle University, Newcastle, UK
| | - Paul Wellman
- Evelina Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - David A Harrison
- Clinical Trials Unit, Intensive Care National Audit and Research Centre, London, UK
| | - Kathryn M Rowan
- Clinical Trials Unit, Intensive Care National Audit and Research Centre, London, UK
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The Effect of Acetaminophen on Temperature in Critically Ill Children: A Retrospective Analysis of Over 50,000 Doses. Pediatr Crit Care Med 2018; 19:204-209. [PMID: 29227436 DOI: 10.1097/pcc.0000000000001426] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Acetaminophen is widely used in PICUs. Although randomized controlled trials suggest that acetaminophen significantly reduces body temperature in adults, the effect of acetaminophen on temperature in critically ill children has not been previously quantified. DESIGN Retrospective observational cohort study. SETTING Single-center general and cardiac PICU in a specialist children's hospital. PATIENTS All children who received acetaminophen or had a fever (temperature ≥ 38°C) while on the ICU over a 40-month period (September 2012 to December 2015). INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS In total, 58,177 doses of acetaminophen were administered, with temperature data available for analysis for 54,084 doses. Temperature decreased by 0.11°C (95% CI, 0.09-0.14°C) 4 hours post acetaminophen dose, after adjustment for weight and illness severity. In children who had a fever and were given acetaminophen, temperature decreased by 0.78°C (95% CI, 0.74-0.82°C). Temperature decreased by 0.88°C (95% CI, 0.85-0.92°C) in children who had fever but did not receive acetaminophen. The change in temperature associated with fever was significantly different between those who did and did not receive acetaminophen (likelihood ratio statistic 246.06; p < 2.2 × 10(-16)). CONCLUSIONS Acetaminophen is associated with a significant decrease in temperature in children with fever. However, temperature may decrease following fever without acetaminophen in the PICU. The threshold to use acetaminophen must be understood to determine the true effect on temperature in any future trials.
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