Pediatric Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Della Commenda 9, 20122, Milan, Italy.
Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy.
Eur J Pediatr. 2024 Nov;183(11):4969-4979. doi: 10.1007/s00431-024-05753-7. Epub 2024 Sep 23.
Guidelines advocate that the symptomatic management of fever should prioritize alleviating the child's discomfort. We investigated the definition and assessment of discomfort in febrile children within the scientific pediatric literature. A systematic review was conducted in accordance with PRISMA 2020 guidelines and preregistered on the Prospero database (CRD42023471590). Databases including PubMed, Embase, and Cochrane were searched. Studies addressing discomfort in febrile children were eligible. Out of 794 initially identified articles, 27 original studies and seven guidelines specifically used the term 'discomfort'. Only 14 original articles provided a definition of discomfort, revealing substantial heterogeneity and no clear-cut definition. Discomfort was often assessed subjectively, predominantly through parent or self-report, and only two studies used a scoring system for assessment. The definitions varied widely, with terms such as crying, irritability, shivering and chills, pain and distress, goosebumps commonly used and evaluation of observable modifications such as facial modifications. Overall, no consensus on a single, standardized definition was available.
This systematic review shows the absence of a standardized definition and assessment of discomfort in febrile children. The findings of the present analysis might be the basis for building a consensus and developing a new tool to evaluate discomfort.
• Discomfort is currently considered the main criterion to guide antipyretic administration in children with fever. • Despite this clear-cut recommendation, it has been questioned whether a commonly accepted understanding and assessment of this condition exists.
• This systematic review identifies a significant heterogeneity in definitions and assessment of discomfort in children with fever. • Both subjective parameters and observable modifications in physiological parameters should be included in a new and shared characterization of discomfort.
评估发热患儿不适的定义和评估在儿科文献中的现状。
按照 PRISMA 2020 指南进行系统综述，并在 Prospero 数据库（CRD42023471590）进行预先注册。检索 PubMed、Embase 和 Cochrane 等数据库。纳入评估发热患儿不适的研究。
最初确定的 794 篇文章中，有 27 项原始研究和 7 项指南专门使用了“不适”一词。仅有 14 项原始文章提供了不适的定义，揭示出显著的异质性和缺乏明确的定义。不适通常是主观评估的，主要通过父母或自我报告，只有两项研究使用了评估的评分系统。定义差异很大，常用术语包括哭泣、烦躁、颤抖和发冷、疼痛和痛苦、鸡皮疙瘩以及评估面部变化等可观察到的变化。总体而言，目前没有关于单一、标准化定义的共识。
本系统综述表明，发热患儿不适缺乏标准化的定义和评估。本分析的结果可能为建立共识和开发新的评估不适的工具提供基础。
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