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Pediatric emergency department nurses perspectives on fever in children

POIRIER, MICHAEL P. MD; DAVIS, PARIS H.; GONZALEZ-DEL REY, JAVIER A. MD; MONROE, KATHY W. MD

Original Articles

Background: Fever is the most common complaint of children seen in a Pediatric Emergency Department (PED). Since pediatric emergency nurses commonly educate parents on fever management, this study sought to examine their knowledge base regarding fever in children.

Methods: Through convenience sampling, pediatric emergency registered nurses working at one of four PEDs were surveyed using a self-administered questionnaire containing 10 open-ended questions pertaining to fever in children.

Results: Eighty-eight pediatric emergency registered nurses (median experience 8.0 years, range 3 months to 28 years) were surveyed. The median temperature considered by pediatric emergency nurses to be a fever was 38.0°C (100.4° F) with a range of 37.2°C (99.0° F) to 38.9°C (102.0° F), while the median temperature considered to be dangerous to a child was 40.6°C (105.0° F) with a range of 38.0°C (100.4° F) to 41.8°C (107.0° F). Eleven percent was not sure what temperature constituted a fever while 31% was not sure what temperature would be dangerous to a child. Fifty-seven percent considered seizures the primary danger to a febrile child while 29% stated permanent brain injury or death could occur from a high fever. Sixty percent chose acetaminophen as first line treatment while 7% stated alcohol or tepid water baths were also acceptable treatment options. Thirty-eight percent stated that a different medication should be added if a child was still febrile 1 hour after initial treatment while 31% would not use additional medication. Eighteen percent stated it was dangerous for a child to leave the PED if still febrile.

Conclusion: Fever phobia and inconsistent treatment approaches occur among experienced pediatric emergency registered nurses. These phobias and inconsistencies subsequently could be conveyed to parents. In order to assure accurate parental education, PEDs should educate their medical team regarding the management of fever in children.

From the Division of Pediatric Emergency Medicine, Eastern Virginia Medical School, Children’s Hospital of The King’s Daughters, Norfolk, Virginia (M.P. Poirier, P.H. Davis); the Division of Pediatric Emergency Medicine, University of Cincinnati School of Medicine, Children’s Hospital Medical Center, Cincinnati, Ohio (J.A. Gonzalez-del Rey); and the Division of Pediatric Emergency Medicine, University of Alabama School of Medicine, The Children’s Hospital of Alabama, Birmingham, Alabama (K.W. Monroe).

Address for reprints: Michael P. Poirier, MD, Division of Emergency Medicine, Children’s Hospital of The King’s Daughters, 601 Children’s Lane, Norfolk, Virginia 23507; email: mpoirier@chkd.com

Presented, in part, at the American Academy of Pediatrics Annual Meeting, San Francisco, CA, October 16, 1998.

We thank the nurses who participated in this study and who play such a vital role in the treatment of children in the Pediatric Emergency Department. We also thank Julie Cross for assistance with the manuscript.

© 2000 Lippincott Williams & Wilkins, Inc.