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.
