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.

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