The Effective Management of Fever in Pediatrics and Insights on Remote Management: Experts' Consensus Using a Delphi Approach

Abstract

BackgroundEven after the publication of the 2017 update of Italian guidelines on treatment of fever in pediatrics, some fundamental questions are still open and new ones emerged during the COVID-19 pandemic.ObjectiveTo assess the level of consensus among Italian pediatricians on different topics related to treatment of fever in children by using the Delphi technique.MethodsA Delphi study was undertaken between June and September 2021, when two questionnaires were consecutively sent to a panel of experts to be answered anonymously. An invitation to participate was sent to 500 pediatricians distributed over the whole national territory and 80 (16%) of them accepted to participate on a voluntary basis. The questionnaires were structured into three specific topics: “therapeutic appropriateness and management of the febrile child,” “management of the febrile child in the presence of other diseases,” and “future perspectives in remote management.” Each topic had six statements.ResultsA first-round questionnaire was sent to 80 accepting pediatricians from different Italian regions. Of the 72 respondents (23% working in hospitals and 72% outside), 33% were from northern, 12% central, and 55% southern Italy or islands. A second-round questionnaire was sent to the same 80 pediatricians and 69 of them responded, without significant differences for workplaces or geographical distribution as compared with the first questionnaire. Overall, 75 participants answered at least one of the two questionnaires. All the statements on the topics of “therapeutic appropriateness and management of the febrile child” and “future perspectives in remote management” reached the predefined cut off for consensus (75% or more). Only one statement on “management of the febrile child in the presence of other diseases” did not achieve the consensus even after the second round.ConclusionsItalian pediatricians agree on several aspects of treatment of febrile children and their expert opinions could support everyday decision process complementary to recommendations by regulatory agencies and guidelines.

Determinants of caregiver's knowledge and practices regarding childhood fever management in a developing setting: a multi-centre cross-sectional assessment

“…Like in previous studies, paracetamol was found to be the most frequently used antipyretic medication (next was ibuprofen) among the surveyed study participants ( 19 , 36 , 42 ), even though it may not be more effective than ibuprofen especially among under-fives ( 15 , 35 , 36 , 50 , 51 ) nor safer ( 15 , 20 , 52 ). The popularity and wide acceptance of paracetamol (over ibuprofen) may be related to its being in clinical practice much longer, recommended by all CPGs and expert consensus guide ( 15 , 16 , 23 ), for all age groups including preterm infants ( 15 , 51 ). The safety concern of paracetamol is probably due to its toxic level being attained much sooner and causes more deaths than the supratherapeutic doses of ibuprofen ( 15 ).…”

“…Due to the ubiquitous nature of fever, it has been extensively studied with clinical practice guidelines (CPGs) ( 22 ) and expert consensus ( 16 , 23 ) published on it; yet recommendation-practice gap persists even among healthcare providers. With regards to caregivers this gap leads to irrational use of antipyretics- such as alternating or combining antipyretic in a fever episode which may lead to confusion, dosing errors, toxicities and sometimes fatalities ( 11 , 15 , 20 , 21 , 24 ).…”