Management of fever in Australian children: a population-based sample survey

Abstract

Background: Fever in childhood is a common acute presentation requiring clinical triage to identify the few children who have serious underlying infection. Clinical practice guidelines (CPGs) have been developed to assist clinicians with this task. This study aimed to assess the proportion of care provided in accordance with CPG recommendations for the management of fever in Australian children. Methods: Clinical recommendations were extracted from five CPGs and formulated into 47 clinical indicators for use in auditing adherence. Indicators were categorised by phase of care: assessment, diagnosis and treatment. Patient records from children aged 0 to 15 years were sampled from general practices (GP), emergency departments (ED) and hospital admissions in randomly-selected health districts in Queensland, New South Wales and South Australia during 2012 and 2013. Paediatric nurses, trained to assess eligibility for indicator assessment and adherence, reviewed eligible medical records. Adherence was estimated by individual indicator, phase of care, age-group and setting. Results: The field team conducted 14,879 eligible indicator assessments for 708 visits by 550 children with fever in 58 GP, 34 ED and 28 hospital inpatient settings. For the 33 indicators with sufficient data, adherence ranged from 14.7 to 98.1%. Estimated adherence with assessment-related indicators was 51.3% (95% CI: 48.1-54.6), 77.5% (95% CI: 65.3-87.1) for diagnostic-related indicators and 72.7% (95% CI: 65.3-79.3) for treatment-related indicators. Adherence for children < 3 months of age was 73.4% (95% CI: 58.0-85.8) and 64.7% (95% CI: 57.0-71.9) for children 3-11 months of age, both significantly higher than for children aged 4-15 years (53.5%; 95% CI: 50.0-56.9). The proportion of adherent care for children attending an ED was 77.5% (95% CI: 74.2-80.6) and 76.7% (95% CI: 71.7-81.3) for children admitted to hospital, both significantly higher than for children attending a GP (40.3%; 95% CI: 34.6-46.1). Conclusions: This study reports a wide range of adherence by clinicians to 47 indicators of best practice for the management of febrile children, sampled from urban and rural regions containing 60% of the Australian paediatric population. Documented adherence was lowest for indicators related to patient assessment, for care provided in GP settings, and for children aged 4-15 years.

Australian care givers' knowledge of and attitudes towards paediatric fever management

“…In Australia, there have been limited studies that attempt to understand the current knowledge of care givers and what may cause them to poorly manage fever in their children. 13,21,22 While these have provided information on the current practices of fever management by Australian care givers, as well as hypothesise factors which influence them, not all tools have been validated 17 nor are up-to-date with current guidelines and practices. 18 Our survey therefore provides a current and comprehensive view of Australian care givers' knowledge and attitudes and the relationship between these factors.…”

The quality of diagnostic guidelines for children in primary care: A meta‐epidemiological study

“…Adherence to clinical practice guidelines (CPGs) is used as a metric of the quality of health service provision 4 . A series of population studies in Australia reported adherence to national and international CPG treatment guidance approximately 60% of the time for 17 common childhood conditions; this ranged from 43% for preventative care, 5 54% for fever 6 and 60% for acute gastroenteritis 7 . CPG adherence was generally lowest in the primary care setting when compared with inpatient and emergency care.…”

Fever without a source in children: international comparison of guidelines

“…Moreover, adherence to FWS guidelines in the Netherlands was only 50% which indicates room for improving implementation of guideline recommendations or the recommendations themselves [ 13 ]. An Australian study showed a wide range of adherence across FWS recommendation categories and age groups [ 37 ]. They measured lower adherence in older children, where our findings stated most inconsistency between the Australian guidelines in children older than one month.…”