Published online Mar 9, 2024. doi: 10.5409/wjcp.v13.i1.88864
Peer-review started: October 13, 2023
First decision: December 11, 2023
Revised: December 17, 2023
Accepted: January 4, 2024
Article in press: January 4, 2024
Published online: March 9, 2024
Fever is a common cause of medical consultations and hospital admissions in children. It is a physiological elevation in body temperature in response to various conditions. Recently, the United Kingdom’s National Institute for Health and Care Excellence (NICE) updated its guidelines for assessing fever in children under five years of age. The presence of fever and proper fever assessment can have a significant impact on investigations, management plans, and the overall prognosis of patients.
Many studies on fever assessment in children have been reported worldwide; however, no such studies have been conducted in Bahrain. This gap motivated us to evaluate the current practices of fever assessment.
To evaluate the current practice of fever assessment in hospitalized children under five years in the main hospital in Bahrain and to assess its adherence to the NICE Fever in under 5s guideline.
We retrospectively reviewed the electronic medical records of children under five years of age admitted to the Department of Pediatrics, Salmaniya Medical Complex, Bahrain, between June and July 2023. Demographic data, vital signs during the first 48 h of admission, route of temperature measurement, and indications for admission were collected. The children were divided into five groups according to their age in months. The NICE Fever in under 5s guideline was used to define fever. Febrile and afebrile patients were compared in terms of demography, indication of admission, route of temperature measurement, and other vital signs. Compliance with the NICE guideline was assessed.
Of the 136 patients reviewed, 80 (58.8%) were boys. The median age at admission was 14.2 [interquartile range (IQR): 1.7-44.4] months. Thirty-six (26.4%) patients had fever, and 100 (73.6%) were afebrile. The commonest age group of febrile patients was higher (> 12-36 months) than for the group without fever (0-3 months) (P = 0.027). The median weight was 8.3 (IQR: 4.0-13.3) kg. Patients with fever had higher weight than those without [10.2 (IQR: 7.3-13.0) vs 7.1 (IQR: 3.8-13.3) kg, respectively] (P = 0.034). Gastrointestinal disease was the leading indication for hospital admission (n = 47, 34.6%). Patients with central nervous system diseases and fever of unknown etiology were more likely to be febrile (P = 0.030 and P = 0.011, respectively). The mean heart rate was higher in the febrile group than the afebrile group (140 ± 24 vs 126 ± 20 beats per minute, respectively) [P = 0.001 (confidence interval: 5.8-21.9)] with a positive correlation between body temperature and heart rate, r = 0.242, n = 136, P = 0.004. A higher proportion of febrile patients received paracetamol (n = 35, 81.3%) than the afebrile patients (n = 8, 18.6%) (P < 0.001). The axillary route was most commonly used for temperature measurements (n = 40/42, 95.2%), followed by the rectal route (n = 2/42, 4.8%). The department demonstrated full compliance with the NICE guideline for five criteria: type of thermometer, route and frequency of temperature measurement, frequency of heart rate measurement, and use of antipyretics as needed. Partial compliance was noted for two criteria, the threshold of fever at 38 °C or more, and the respiratory rate assessment in febrile patients. Minimal compliance or no record was observed for the remaining three criteria (routine assessment of capillary refill, temperature reassessment 1-2 h after each antipyretic intake, and refraining from the use of tepid sponging).
The evaluation of fever in children under five years of age revealed areas of adherence to the guideline and areas that require enhancement. Specific noteworthy findings have emerged, such as a higher number of boys being admitted to the hospital, a common occurrence of gastrointestinal diseases, a significant difference in weight between febrile and afebrile patients, and an underuse of tympanic thermometry despite its established accuracy and convenience.
Specific improvements in fever assessment in children under the age of five years should be implemented in accordance with international guidelines. Further studies exploring the sex disparities, indications for admission, and weight differences between febrile and afebrile patients are warranted. Furthermore, the use of tympanic thermometry for temperature assessment in children should be explored.