Fever and clinical thermometry: What do physicians and nurses really know?
Introduction: Fever is a leading cause of Pediatric visits. However, most studies used as reference for fever assessment had a cross-sectional design and were conducted in adults. Different and more precise fever definitions exist within the field of knowledge known as clinical thermometry.
Aims: To assess basic knowledge of health professionals working in Pediatrics regarding fever physiopathology and clinical thermometry. Material and Methods: A cross-sectional analytical study was performed between February and July 2014 through application of an anonymous closed-end questionnaire to health professionals.
Results: From 426 questionnaires applied, 29% were completed by nurses and 71% by physicians. Within the whole group, 89% did not know how human “normal temperature” was determined, 70% did not recognize the “individual definitions” of fever, 33% acknowledged a “subfebrile” status, 39% did not recognize the most and least accurate anatomical sites for temperature measurement, and 57% did not recognize the dynamic difference between core and peripheral temperatures. Hyperthermia and fever definitions were confounded by 78% of nurses and 56% of physicians.
Conclusions: Most health professionals surveyed had a limited knowledge of fever and clinical thermometry. The traditional oversimplification of this subject can lead to underestimation of true febrile statuses.
2. El-Radhi AS, Carroll J, Klein N. Clinical Manual of Fever in Children. 1st edition. Berlin: Springer-Verlag; 2009.
3. García Puga JM, Garrido Torrecillas FJ, Hernández Morillas D, Castillo Díaz L, Santos Pérez JL, Callejas Pozo JE, et al. Analysis of the theoretical knowledge and clinical management of fever by paediatricians and medical residents in relation to an established care protocol. Rev Pediatr Aten Primaria 2012; 14:117-30.
4. Herzog L, Phillips S. Addressing concerns about fever. Clin Pediatr (Phila) 2011; 50:383-90.
5. Karwowska A, Nijssen-Jordan C, Johnson D, Dele Davies H. Parental and health care provider understanding of childhood fever: a canadian perspective. CJEM. 2002; 4:394-400.
6. National Collaborating Centre for Women’s and Children’s Health (UK), Royal College of Obstetricians & Gynaecologists (UK), National Institute for Health and Care Excellence: Clinical Guidelines. Feverish illness in children: assessment and initial management in children younger than 5 years. 2013.
7. Bertille N, Purssel E, Corrard F, Chiappini E, Chalumeau M. Fever phobia 35 years later: did we fail? Acta Paediatr 2015; 105:9-10.
8. Chiappini E, Parretti A, Becherucci P, Pierattelli M, Bonsignori F, Galli L, et al. Parental and medical knowledge and management of fever in Italian pre-school children. BMC Pediatrics 2012; 12:97-106.
9. Purssel E, Collin J. Fever phobia: the impact of time and mortality – a systematic review and meta-analysis. Int J Nurs Stud 2016; 56:81-9.
10. Raffaeli G, Orenti A, Gambino M, Peves Rios W, Bosis S, Bianchini S, et al. Fever and pain management in childhood: healthcare providers’ and parents’ adherence to current recommendations. Int J Environ Res Public Health. 2016; 13:E499.
11. Al-Eissa YA, Al-Zaben AA, Al-Wakeel AS, Al-Alola SA, Al-Shaalan MA, Al-Amir AA, et al. Physician’s perceptions of fever in children. Saudi Med J 2001; 22:124-8.
12. Chiappini E, D’Elios S, Mazzantini R, Becherucci P, Pierattelli M, Galli L, et al. Adherence among italian paediatricians to the italian guidelines for the management of fever in children: a cross sectional survey. BMC Pediatr 2013; 13:210.
13. Kluger M. Is fever beneficial? In: El-Radhi AS, Carroll J, Klein N. Clinical Manual of Fever in Children. Springer-Verlag, Berlin, 2009; 211-22.
14. Martins M, Abecasis F. Healthcare professionals approach paediatric fever in significantly different ways and fever phobia is not just limited to parents. Acta Paediatr. 2016; 105:829-33.
15. Mackowiak PA. Temperature regulation and the pathogenesis of fever. In: Bennett JE, Dolin R, Blaser MJ. Mandell, Douglas, and Bennett’s Principles and Practice of Infectious Diseases, 8th edition. Elsevier Saunders, 2015; 765-78.
16. Mackowiak PA, Wasserman SS. Physicians’ perceptions regarding body temperature in health and disease. South Med J 1995; 88:934-8.
17. Quast S, Kimberger O. The significance of core temperature – Pathophysiology and measurement methods. Dräger Medical GmbH, Germany, 2015.
18. Salgado M. O subfebril não existe: é uma mentira contada inúmeras vezes que se transformou numa verdade. Saúde Infantil 2014; 36:55-7.
19. Ward MA, Parcells CL. Fever: Pathogens and treatment. In: Cherry JD, Harrison GJ, Kaplan SL, Steinbach WJ, Hotez PJ. Feigin and Cherry’s Textbook of Paediatric Infectious Diseases, 7th edition. Elsevier, Philadelphia, 2014.
20. Taylor NAS, Tipton MJ, Kenny GP. Considerations for the measurement of core, skin and mean body temperatures (review). J Therm Biol 2014; 46:72-101.
21. Fever and Hyperthermia. In: Longo DL, Kasper DL, Jameson JL, Fauci AS, Hauser SL, Loscalzo J. Harrison Principles of Internal Medicine, 18th edn. The McGraw-Hill Companies, United States of America, 2011; 373-83.
22. Morley CJ, Hewson PH, Thornton AJ, Cole TJ. Axillary and rectal temperature measurements in infants. Arch Dis Child 1992; 67:122-5.
23. Kelly G. Body Temperature Variability (Part 1): A Review of the History of Body Temperature and its Variability Due to Site Selection, Biological Rhythms, Fitness, and Aging. Altern Med Rev. 2006; 11:278-93.
24. Kayman H. Management of fever: making evidence-based decisions. Clin Pediatr (Phila) 2003; 42:383-92.
25. Purssell E. Fever in children – a concept analysis. J Clin Nurs 2013; 23:3575–82.
26. Cherry JD, Harrison GJ, Kaplan SL, Steinbach WJ, Hotez PJ. Feigin and Cherry’s Textbook of Paediatric Infectious Diseases. 7th edition. Elsevier, Philadelphia, 2014.
27. Longo DL, Kasper DL, Jameson JL, Fauci AS, Hauser SL, Loscalzo J. Harrison Principles of Internal Medicine, 18th edition. The McGraw-Hill Companies, United States of America, 2011.
28. Sund-Levander M, Grodzinsky E. Time for a change to assess and evaluate body temperature in clinical practice. Int J Nurs Pract. 2009; 15:241-9.
29. Affronti M, Mansueto P, Soresi M, Abbene AM, Affronti A, Valenti M, et al. Low-grade fever: how to distinguish organic from non-organic forms. Int J Clin Pract 2010; 64:316-21.
30. Werne J. Measurements of temperature of human body. Reference module in biomedical sciences. Comprehensive Miomedical Physics 2014; 5:107-51.
31. Brown RD, Kearns G, Eichler VF, Wilson JT. A probability nomogram to predict rectal temperature in children. Clin Pediatr (Phila) 1992; 31:523-31.
32. Leduc D, Woods S, Community Paediatrics Committee, Canadian Paediatric Society, Position Statement. Temperature measurement in paediatrics. January 2013 (acessed May 2016). Available at: www.cps.ca/en/documents/position/temperaturemeasurement.
33. Oguz F, Yildiz I, Varkal MA, Hizli Z, Toprak S, Kaymakci K, et al. Axillary and tympanic temperature measurement in children and normal values for ages. Pediatr Emerg Care. 2018; 34:169-73.
34. Walker GA, Runde D, Rolston DM, Wiener D, Lee J. Emergency department rectal temperatures in over 10 years: a retrospective observational study. World J Emerg Med 2013; 4:107-12.
35. Teller J, Ragazzi M, Simonetti GD, Lava SA. Accuracy of tympanic and forehead thermometers in private paediatric practice. Acta Paediatr. 2014; 103 e80-3.
36. Lava SAG, Simonetti GD, Ramelli GP, Tschumi S, Bianchetti MG. Symptomatic management of fever by Swiss board-certified pediatricians: results from a cross-sectional, web-bases survey. Clin Therap 2012; 34:250-6.
37. Paes BF, Vermeulen K, Brohet RM, van der Ploeg T, de Winter JP. Accuracy of tympanic and infrared skin thermometers in children. Arch Dis Child. 2010; 95:974-8.
38. El Khoury AC, Durden E, Ma L, Markson LE, Lee AW, Duan Y, et al. Perception and management of fever in infants up to six months of age: A survey of US pediatricians. BMC Pediatr. 2010; 10:95. doi: 10.1186/1471-2431-10-95.
39. Sermet-Gaudelus I, Chadelat I, Lenoir G. Body temperature measurement in daily practice. Arch Pédiatr (Paris) 2005; 12:1292-300.
40. Barbi E, Marzuillo P, Neri E, Naviglio S, Krauss BS. Fever in Children: Pearls and Pitfalls. Children (Basel). 2017; 4:81.
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