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Symptomatic fever management in children: A systematic review of national and international guidelines

Cari Green, View ORCID ProfileHanno Kraft, Gordon Guyatt, David Martin
doi: https://doi.org/10.1101/2021.01.11.426184
Cari Green
1Gerhard Kienle Chair, Health Department, University of Witten/Herdecke, Herdecke, Germany
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Hanno Kraft
1Gerhard Kienle Chair, Health Department, University of Witten/Herdecke, Herdecke, Germany
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  • ORCID record for Hanno Kraft
Gordon Guyatt
2Departments of Health Research Methods, Evidence and Impact and Medicine at McMaster University, Hamilton, Canada
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David Martin
1Gerhard Kienle Chair, Health Department, University of Witten/Herdecke, Herdecke, Germany
3University Children’s Hospital, Tübingen University, Tübingen, Germany
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  • For correspondence: david.martin@uni-wh.de
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Abstract

Introduction A comprehensive assessment of the recommendations made by clinical practice guidelines (CPGs) on symptomatic fever management in children has not been carried out.

Methods Searches were conducted on Pubmed, google scholar, pediatric society websites and guideline databases to locate CPGs from each country. Rather than assessing overall guideline quality, the level of evidence for each recommendation was evaluated according to criteria of the Oxford Centre for Evidence-Based Medicine (OCEBM). A GRADE assessment was undertaken to assess the body of evidence related to a single question: the threshold for initiating antipyresis.

Results 74 guidelines were retrieved. Recommendations for antipyretic threshold, type and dose; ambient temperature; dress/covering; activity; fluids; nutrition; proctoclysis; external applications; complementary/herbal recommendations; media; and age-related treatment differences all varied widely. OCEBM evidence levels for most recommendations were low (Level 3-4) or indeterminable. The GRADE assessment revealed a very low level of evidence for a threshold for antipyresis.

Conclusion There is no recommendation on which all guidelines agree, and many are inconsistent with the evidence – this is true even for recent guidelines. The threshold question is of fundamental importance and has not yet been answered. Guidelines for the most frequent intervention (antipyresis) remain problematic.

Footnotes

  • Source of funding: No funding was requested for this study.

  • Financial disclosure: The authors have no financial ties relevant to this article.

  • Conflict of interest: The authors have no conflicts of interest.

Copyright 
The copyright holder for this preprint is the author/funder, who has granted bioRxiv a license to display the preprint in perpetuity. It is made available under a CC-BY 4.0 International license.
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Posted January 11, 2021.
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Symptomatic fever management in children: A systematic review of national and international guidelines
Cari Green, Hanno Kraft, Gordon Guyatt, David Martin
bioRxiv 2021.01.11.426184; doi: https://doi.org/10.1101/2021.01.11.426184
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Symptomatic fever management in children: A systematic review of national and international guidelines
Cari Green, Hanno Kraft, Gordon Guyatt, David Martin
bioRxiv 2021.01.11.426184; doi: https://doi.org/10.1101/2021.01.11.426184

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