Department of Surgery, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand.
Emergency Department, Middlemore Hospital, Auckland, New Zealand.
Emerg Med Australas. 2022 Dec;34(6):943-953. doi: 10.1111/1742-6723.14022. Epub 2022 May 29.
To assess (i) paediatric fever management practices among New Zealand ED doctors and nurses, including adherence to best practice guidelines; and (ii) the acceptability of a randomised controlled trial (RCT) of antipyretics for relief of discomfort in young children.
A cross-sectional survey of doctors and nurses across 11 New Zealand EDs. The primary outcome of adherence to paediatric fever management best practice guidelines was assessed with clinical vignettes and defined as single antipyretic use for the relief of fever-related discomfort.
Out of 602 participants (243 doctors, 353 nurses and six unknown; response rate 47.5%), only 64 (10.6%, 95% confidence interval [CI] 8.3-13.4%) demonstrated adherence to best practice guidelines. In a febrile settled child with normal fluid intake, the percentage of participants that would use antipyretics doubled with abnormal vital signs (33.7% vs 72.9%, difference -39.2%, 95% CI -44.4% to -34.0%). Most participants would use antipyretics for reduced fluid intake (n = 494, 82.1%, 95% CI 78.8-85.0%) in a febrile settled child. Over half (n = 339, 57.1%, 95% CI 53.0-61.1%) would advise giving antipyretics to prevent febrile convulsions. Most (n = 467, 80.0%, 95% CI 76.5-83.1%) participants agreed that a RCT of antipyretics in febrile children <2 years of age with relief of discomfort as a primary outcome is needed.
Just over 10% of New Zealand ED doctors and nurses demonstrated adherence to paediatric fever management best practice guidelines. A RCT of antipyretics in febrile children <2 years of age specifically addressing relief of discomfort as a primary outcome is strongly supported.
评估新西兰急诊科医生和护士对儿科发热管理的实践情况，包括对最佳实践指南的依从性；并评估解热药缓解幼儿不适的随机对照试验（RCT）的可接受性。
对新西兰 11 家急诊科的医生和护士进行横断面调查。采用临床病例评估对儿科发热管理最佳实践指南的依从性作为主要结局，并将单次使用解热药缓解发热相关不适定义为依从。
在 602 名参与者中（243 名医生、353 名护士和 6 名未知；应答率为 47.5%），只有 64 名（10.6%，95%置信区间[CI]8.3-13.4%）符合最佳实践指南。在发热已缓解且液体摄入正常的儿童中，出现异常生命体征时使用解热药的参与者比例增加了一倍（33.7%比 72.9%，差异为-39.2%，95%CI-44.4%至-34.0%）。在发热已缓解且液体摄入减少的儿童中，大多数参与者（n=494，82.1%，95%CI 78.8-85.0%）会使用解热药。超过一半（n=339，57.1%，95%CI 53.0-61.1%）的参与者会建议使用解热药预防热性惊厥。大多数（n=467，80.0%，95%CI 76.5-83.1%）参与者认为，需要进行一项 RCT，评估解热药在 2 岁以下发热儿童中的应用，以缓解不适为主要结局。
新西兰急诊科医生和护士中只有 10%以上的人符合儿科发热管理最佳实践指南。强烈支持开展一项 RCT，专门评估解热药在 2 岁以下发热儿童中的应用，以缓解不适为主要结局。
