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Fever systematic reviews

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Analysis of Nurses' and Physicians' Attitudes, Knowledge, and Perceptions toward Fever in Children: A Systematic Review with Meta-Analysis.

Visit

Vicens-Blanes F, Mir-Bonet R, Molina-Mula J.

To investigate whether doctors' and nurses' knowledge, perceptions, and attitudes toward fever influence how this sign is managed. Furthermore, it intends to evaluate whether educational programs increase knowledge and change attitudes and/or perceptions of nurses about children's fever.

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

Visit

Green C, Krafft H, Guyatt G, Martin D.

Divergent attitudes towards fever have led to a high level of inconsistency in approaches to its management. In an attempt to overcome this, clinical practice guidelines (CPGs) for the symptomatic management of fever in children have been produced by several healthcare organizations. To date, a comprehensive assessment of the evidence level of the recommendations made in these CPGs has not been carried out.

Predictors of disease severity in children presenting from the community with febrile illnesses: a systematic review of prognostic studies

Visit

Chandna A, Tan R, Carter M, Van Den Bruel A, Verbakel J, Koshiaris C, et al

Early identification of children at risk of severe febrile illness can optimise referral, admission and treatment decisions, particularly in resource-limited settings. We aimed to identify prognostic clinical and laboratory factors that predict progression to severe disease in febrile children presenting from the community.

Hyperpyrexia and high fever as a predictor for serious bacterial infection (SBI) in children-a systematic review.

Visit

Rosenfeld-Yehoshua N, Barkan S, Abu-Kishk I, Booch M, Suhami R, Kozer E.

It is not clear if children with high fever are at increased risk for serious bacterial infection (SBI). Our aim was to systematically review if children suffering from high fever are at high risk for SBI.

Prescribing Controversies: An Updated Review and Meta-Analysis on Combined/Alternating Use of Ibuprofen and Paracetamol in Febrile Children.

Visit

Trippella G, Ciarci M, de Martino M, Chiappini E.

To compare the efficacy and safety of combined or alternating use of ibuprofen and paracetamol in children.

Educational interventions on fever management in children: A scoping review

Visit

Arias D, Chen TF, Moles RJ.

To collect and examine peer-reviewed literature for active educational interventions aimed at improving fever management in children and profile them based on: who provided the training, training location, how the intervention was delivered, outcomes of training, and how it was measured.

Fever in under 5s: assessment and initial management.

Visit

National Institute for Health and Care Excellence (NICE)

This guideline covers the assessment and early management of fever with no obvious cause in children aged under 5. It aims to improve clinical assessment and help healthcare professionals diagnose serious illness among young children who present with fever in primary and secondary care. This guideline should be read in conjunction with the NICE guidelines on sepsis, neonatal infection, meningitis (bacterial) and meningococcal septicaemia in under 16s, urinary tract infection in under 16s, diarrhoea and vomiting caused by gastroenteritis in under 5s and antimicrobial prescribing for common infections.

Review: During the Emergency Department Evaluation of a Well-Appearing Neonate with Fever, Should Empiric Acyclovir Be Initiated?

Visit

Bruno E, Pillus D, Cheng D, Vilke G, Pokrajac N

This review aimed to identify when to initiate testing and treatment for herpes simplex virus infection.

Review: Facing the ongoing challenge of the febrile young infant

Visit

DePorre AG, Aronson PL, McCulloh RJ

The authors highlight the historical context of febrile infant management, review important definitions and terminology, discuss the most clinically relevant viral and bacterial causes of fever in the young infant, describe current risk stratification tools guiding medicaldecision making, and outline research and clinical practice improvement priorities for improving the management of the febrile young infant.

Review: Management of the Febrile Young Infant: Update for the 21st Century

Visit

Woll C, Neuman MI, Aronson PL

Newer laboratory investigations such as C-reactive protein and procalcitonin have favorable test characteristics compared with traditional laboratory studies such as a white blood cell count. These novel biomarkers have not gained widespread acceptance because of lack of robust prospectively collected data, varying thresholds to define positivity, and differing inclusion criteria across studies. However, C-reactive protein and procalcitonin, when combined with other patient characteristics in the step-by-step approach, have a high sensitivity for detection of serious bacterial infection.

Fever in Children: Pearls and Pitfalls.

Visit

Barbi E, Marzuillo P, Neri E, Naviglio S, Krauss BS.

Fever in children is a common concern for parents and one of the most frequent presenting complaints in emergency department visits, often involving non-pediatric emergency physicians. Although the incidence of serious infections has decreased after the introduction of conjugate vaccines, fever remains a major cause of laboratory investigation and hospital admissions. Furthermore, antipyretics are the most common medications administered to children. We review the epidemiology and measurement of fever, the meaning of fever and associated clinical signs in children of different ages and under special conditions, including fever in children with cognitive impairment, recurrent fevers, and fever of unknown origin.

Systematic Review: Meta-analysis to Determine Risk for Serious Bacterial Infection in Febrile Outpatient Neonates With RSV Infection

Visit

Bonadio W, Huang F, Nateson S, Okpalaji C, Kodsi A, Sokolovsky S, Homel P

This study aimed to analyze a large group of febrile neonates 28 days or younger who received outpatient sepsis evaluation and nasopharyngeal aspirate antigen testing (NPAT) for respiratory syncytial viral (RSV) infection to determine whether there is a clinically significant association between viral study results and risk for serious bacterial infection (SBI: bacterial meningitis, bacteremia, urinary tract infection, bacterial enteritis).

Drivers for inappropriate fever management in children: a systematic review.

Visit

Kelly M, McCarthy S, O'Sullivan R, Shiely F, Larkin P, Brenner M, Sahm LJ.

The aim of this review was to synthesise qualitative and quantitative evidence on the knowledge, attitudes and beliefs of parents regarding fever and febrile illness in children.

Evaluation and Management of Febrile Children: A Review.

Visit

Cioffredi LA, Jhaveri R.

Management of febrile children is an intrinsic aspect of pediatric practice. Febrile children account for 15% of emergency department visits and outcomes range from the presence of serious bacterial infection to benign self-limited illness.

Systematic Review: Diagnostic utility of biomarkers for neonatal sepsis--a systematic review

Visit

Hedegaard SS, Wisborg K, Hvas AM

The objective of the study was to systematically evaluate existing evidence of the diagnostic utility of biomarkers for prediction of sepsis in neonates.

Review: Neonatal Herpes Simplex Virus Infection

Visit

James SH, Kimberlin DW

This review describes diagnostic and therapeutic advances for infants with herpes simplex virus 1 (HSV-1) and 2 (HSV-2).

Systematic Review: Use of serum procalcitonin in evaluation of febrile infants: a meta-analysis of 2317 patients

Visit

England JT, Del Vecchio MT, Aronoff SC

The objectives of this systematic review and meta-analysis were to determine: 1) the ability of serum procalcitonin concentrations to identify febrile infants < 91 days of age at high and low risk for serious bacterial infections, and 2) to compare its utility with available clinical prediction rules.

Combined and alternating paracetamol and ibuprofen therapy for febrile children.

Visit

Wong T, Stang AS, Ganshorn H, Hartling L, Maconochie IK, Thomsen AM, Johnson DW.

To assess the effects and side effects of combining paracetamol and ibuprofen, or alternating them on consecutive treatments, compared with monotherapy for treating fever in children.

Risk stratification and management of the febrile young child.

Visit

Ishimine P.

Febrile young children present frequently to the emergency department. While most febrile children recover uneventfully, certain subgroups are at higher risk of serious infection. Febrile neonates require extensive diagnostic testing, antibiotic therapy, and hospital admission. Diagnostic testing can be utilized in older patients to identify children at low risk and high risk for serious infection. This information may assist in determining the treatment and disposition of these febrile children.

Evaluation of child with fever without source: review of literature and update

Visit

Arora R, Mahajan P.

Fever is one of the most common reasons for a visit to the primary care provider or the emergency department. Traditionally, clinicians have used various risk-stratification strategies to identify serious bacterial infections (SBI) without an obvious source in febrile children, because missed bacterial infections in such children can result in meningitis, sepsis, and death; therefore, early and accurate identification of SBIs is critical. Infants aged less than 60 to 90 days are at greatest risk of SBI. The epidemiology of SBI continues to evolve, especially after the successful introduction of conjugate vaccines against Streptococcus pneumoniae and Haemophilus influenzae.

Systematic Review: Diagnosis and management of febrile infants (0-3 months)

Visit

Hui C, Neto G, Tsertsvadze A, Yazdi F, Tricco AC, Tsouros S, Skidmore B, Dani...

Objectives: To review the evidence for diagnostic accuracy of screening for serious bacterial illness (SBI) and invasive herpes simplex virus (HSV) infection in febrile infants 3 months or younger; ascertain harms and benefits of various management strategies; compare prevalence of SBI and HSV between different clinical settings; determine how well the presence of viral infection predicts against SBI; and review evidence on parental compliance to return for followup assessments (infants less than 6 months).

Systematic review and validation of prediction rules for identifying children with serious infections in emergency departments and urgent-access primary care.

Visit

Thompson M, Van den Bruel A, Verbakel J, Lakhanpaul M, Haj-Hassan T, Stevens ...

We systematically identified clinical features and laboratory tests which identify serious infection in children attending the ED and primary care. We also identified clinical prediction rules and validated those using existing data sets.

Review: Management of the non-toxic-appearing acutely febrile child: a 21st century approach

Visit

Jhaveri R, Byington CL, Klein JO, Shapiro ED

This review discusses challenges and new approaches to assessment and management of febrile children with suspected serious bacterial infections.

Diagnostic value of laboratory tests in identifying serious infections in febrile children: systematic review

Visit

Van den Bruel A, Thompson MJ, Haj-Hassan T, Stevens R, Moll H, Lakhanpaul M, ...

To collate all available evidence on the diagnostic value of laboratory tests for the diagnosis of serious infections in febrile children in ambulatory settings.

Systematic Review: Systematic review of the diagnostic accuracy of C-reactive protein to detect bacterial infection in nonhospitalized infants and children with fever

Visit

Sanders S, Barnett A, Correa-Velez I, Coulthard M, Doust J

The objective of this systematic review was to determine the accuracy of C-reactive protein (CRP) for diagnosing serious bacterial and bacterial infections in infants and children presenting with fever.

Management of childhood fever by parents: literature review.

Visit

Walsh A, Edwards H.

This paper reports a review which draws together findings from studies targeting parents' temperature-taking, antipyretic administration, attitudes, practices and information-seeking behaviours.

Evaluation and management of infants and young children with fever.

Visit

Luszczak M.

A practice guideline for the management of febrile infants and children younger than three years of age sparked controversy when it was published in 1993. Surveys indicate that many office-based physicians do not agree with recommendations for venipuncture and bladder catheterization in nontoxic febrile children, and that many employ watchful waiting rather than empiric antibiotic therapy. Surveys of parents note a preference for less testing and treatment.

Systematic Review: Temperature measured at the axilla compared with rectum in children and young people: systematic review

Visit

Craig JV, Lancaster GA, Williamson PR, Smyth RL

The objective of this systematic review was to evaluate the agreement between temperature measured at the axilla and rectum in children and young people.

Analysis of Nurses' and Physicians' Attitudes, Knowledge, and Perceptions toward Fever in Children: A Systematic Review with Meta-Analysis.

Visit

Vicens-Blanes F, Mir-Bonet R, Molina-Mula J.

To investigate whether doctors' and nurses' knowledge, perceptions, and attitudes toward fever influence how this sign is managed. Furthermore, it intends to evaluate whether educational programs increase knowledge and change attitudes and/or perceptions of nurses about children's fever.

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

Visit

Green C, Krafft H, Guyatt G, Martin D.

Divergent attitudes towards fever have led to a high level of inconsistency in approaches to its management. In an attempt to overcome this, clinical practice guidelines (CPGs) for the symptomatic management of fever in children have been produced by several healthcare organizations. To date, a comprehensive assessment of the evidence level of the recommendations made in these CPGs has not been carried out.

Predictors of disease severity in children presenting from the community with febrile illnesses: a systematic review of prognostic studies

Visit

Chandna A, Tan R, Carter M, Van Den Bruel A, Verbakel J, Koshiaris C, et al

Early identification of children at risk of severe febrile illness can optimise referral, admission and treatment decisions, particularly in resource-limited settings. We aimed to identify prognostic clinical and laboratory factors that predict progression to severe disease in febrile children presenting from the community.

Hyperpyrexia and high fever as a predictor for serious bacterial infection (SBI) in children-a systematic review.

Visit

Rosenfeld-Yehoshua N, Barkan S, Abu-Kishk I, Booch M, Suhami R, Kozer E.

It is not clear if children with high fever are at increased risk for serious bacterial infection (SBI). Our aim was to systematically review if children suffering from high fever are at high risk for SBI.

Prescribing Controversies: An Updated Review and Meta-Analysis on Combined/Alternating Use of Ibuprofen and Paracetamol in Febrile Children.

Visit

Trippella G, Ciarci M, de Martino M, Chiappini E.

To compare the efficacy and safety of combined or alternating use of ibuprofen and paracetamol in children.

Educational interventions on fever management in children: A scoping review

Visit

Arias D, Chen TF, Moles RJ.

To collect and examine peer-reviewed literature for active educational interventions aimed at improving fever management in children and profile them based on: who provided the training, training location, how the intervention was delivered, outcomes of training, and how it was measured.

Fever in under 5s: assessment and initial management.

Visit

National Institute for Health and Care Excellence (NICE)

This guideline covers the assessment and early management of fever with no obvious cause in children aged under 5. It aims to improve clinical assessment and help healthcare professionals diagnose serious illness among young children who present with fever in primary and secondary care. This guideline should be read in conjunction with the NICE guidelines on sepsis, neonatal infection, meningitis (bacterial) and meningococcal septicaemia in under 16s, urinary tract infection in under 16s, diarrhoea and vomiting caused by gastroenteritis in under 5s and antimicrobial prescribing for common infections.

Review: During the Emergency Department Evaluation of a Well-Appearing Neonate with Fever, Should Empiric Acyclovir Be Initiated?

Visit

Bruno E, Pillus D, Cheng D, Vilke G, Pokrajac N

This review aimed to identify when to initiate testing and treatment for herpes simplex virus infection.

Review: Facing the ongoing challenge of the febrile young infant

Visit

DePorre AG, Aronson PL, McCulloh RJ

The authors highlight the historical context of febrile infant management, review important definitions and terminology, discuss the most clinically relevant viral and bacterial causes of fever in the young infant, describe current risk stratification tools guiding medicaldecision making, and outline research and clinical practice improvement priorities for improving the management of the febrile young infant.

Review: Management of the Febrile Young Infant: Update for the 21st Century

Visit

Woll C, Neuman MI, Aronson PL

Newer laboratory investigations such as C-reactive protein and procalcitonin have favorable test characteristics compared with traditional laboratory studies such as a white blood cell count. These novel biomarkers have not gained widespread acceptance because of lack of robust prospectively collected data, varying thresholds to define positivity, and differing inclusion criteria across studies. However, C-reactive protein and procalcitonin, when combined with other patient characteristics in the step-by-step approach, have a high sensitivity for detection of serious bacterial infection.

Fever in Children: Pearls and Pitfalls.

Visit

Barbi E, Marzuillo P, Neri E, Naviglio S, Krauss BS.

Fever in children is a common concern for parents and one of the most frequent presenting complaints in emergency department visits, often involving non-pediatric emergency physicians. Although the incidence of serious infections has decreased after the introduction of conjugate vaccines, fever remains a major cause of laboratory investigation and hospital admissions. Furthermore, antipyretics are the most common medications administered to children. We review the epidemiology and measurement of fever, the meaning of fever and associated clinical signs in children of different ages and under special conditions, including fever in children with cognitive impairment, recurrent fevers, and fever of unknown origin.

Systematic Review: Meta-analysis to Determine Risk for Serious Bacterial Infection in Febrile Outpatient Neonates With RSV Infection

Visit

Bonadio W, Huang F, Nateson S, Okpalaji C, Kodsi A, Sokolovsky S, Homel P

This study aimed to analyze a large group of febrile neonates 28 days or younger who received outpatient sepsis evaluation and nasopharyngeal aspirate antigen testing (NPAT) for respiratory syncytial viral (RSV) infection to determine whether there is a clinically significant association between viral study results and risk for serious bacterial infection (SBI: bacterial meningitis, bacteremia, urinary tract infection, bacterial enteritis).

Drivers for inappropriate fever management in children: a systematic review.

Visit

Kelly M, McCarthy S, O'Sullivan R, Shiely F, Larkin P, Brenner M, Sahm LJ.

The aim of this review was to synthesise qualitative and quantitative evidence on the knowledge, attitudes and beliefs of parents regarding fever and febrile illness in children.

Evaluation and Management of Febrile Children: A Review.

Visit

Cioffredi LA, Jhaveri R.

Management of febrile children is an intrinsic aspect of pediatric practice. Febrile children account for 15% of emergency department visits and outcomes range from the presence of serious bacterial infection to benign self-limited illness.

Systematic Review: Diagnostic utility of biomarkers for neonatal sepsis--a systematic review

Visit

Hedegaard SS, Wisborg K, Hvas AM

The objective of the study was to systematically evaluate existing evidence of the diagnostic utility of biomarkers for prediction of sepsis in neonates.

Review: Neonatal Herpes Simplex Virus Infection

Visit

James SH, Kimberlin DW

This review describes diagnostic and therapeutic advances for infants with herpes simplex virus 1 (HSV-1) and 2 (HSV-2).

Systematic Review: Use of serum procalcitonin in evaluation of febrile infants: a meta-analysis of 2317 patients

Visit

England JT, Del Vecchio MT, Aronoff SC

The objectives of this systematic review and meta-analysis were to determine: 1) the ability of serum procalcitonin concentrations to identify febrile infants < 91 days of age at high and low risk for serious bacterial infections, and 2) to compare its utility with available clinical prediction rules.

Combined and alternating paracetamol and ibuprofen therapy for febrile children.

Visit

Wong T, Stang AS, Ganshorn H, Hartling L, Maconochie IK, Thomsen AM, Johnson DW.

To assess the effects and side effects of combining paracetamol and ibuprofen, or alternating them on consecutive treatments, compared with monotherapy for treating fever in children.

Risk stratification and management of the febrile young child.

Visit

Ishimine P.

Febrile young children present frequently to the emergency department. While most febrile children recover uneventfully, certain subgroups are at higher risk of serious infection. Febrile neonates require extensive diagnostic testing, antibiotic therapy, and hospital admission. Diagnostic testing can be utilized in older patients to identify children at low risk and high risk for serious infection. This information may assist in determining the treatment and disposition of these febrile children.

Evaluation of child with fever without source: review of literature and update

Visit

Arora R, Mahajan P.

Fever is one of the most common reasons for a visit to the primary care provider or the emergency department. Traditionally, clinicians have used various risk-stratification strategies to identify serious bacterial infections (SBI) without an obvious source in febrile children, because missed bacterial infections in such children can result in meningitis, sepsis, and death; therefore, early and accurate identification of SBIs is critical. Infants aged less than 60 to 90 days are at greatest risk of SBI. The epidemiology of SBI continues to evolve, especially after the successful introduction of conjugate vaccines against Streptococcus pneumoniae and Haemophilus influenzae.

Systematic Review: Diagnosis and management of febrile infants (0-3 months)

Visit

Hui C, Neto G, Tsertsvadze A, Yazdi F, Tricco AC, Tsouros S, Skidmore B, Dani...

Objectives: To review the evidence for diagnostic accuracy of screening for serious bacterial illness (SBI) and invasive herpes simplex virus (HSV) infection in febrile infants 3 months or younger; ascertain harms and benefits of various management strategies; compare prevalence of SBI and HSV between different clinical settings; determine how well the presence of viral infection predicts against SBI; and review evidence on parental compliance to return for followup assessments (infants less than 6 months).

Systematic review and validation of prediction rules for identifying children with serious infections in emergency departments and urgent-access primary care.

Visit

Thompson M, Van den Bruel A, Verbakel J, Lakhanpaul M, Haj-Hassan T, Stevens ...

We systematically identified clinical features and laboratory tests which identify serious infection in children attending the ED and primary care. We also identified clinical prediction rules and validated those using existing data sets.

Review: Management of the non-toxic-appearing acutely febrile child: a 21st century approach

Visit

Jhaveri R, Byington CL, Klein JO, Shapiro ED

This review discusses challenges and new approaches to assessment and management of febrile children with suspected serious bacterial infections.

Diagnostic value of laboratory tests in identifying serious infections in febrile children: systematic review

Visit

Van den Bruel A, Thompson MJ, Haj-Hassan T, Stevens R, Moll H, Lakhanpaul M, ...

To collate all available evidence on the diagnostic value of laboratory tests for the diagnosis of serious infections in febrile children in ambulatory settings.

Systematic Review: Systematic review of the diagnostic accuracy of C-reactive protein to detect bacterial infection in nonhospitalized infants and children with fever

Visit

Sanders S, Barnett A, Correa-Velez I, Coulthard M, Doust J

The objective of this systematic review was to determine the accuracy of C-reactive protein (CRP) for diagnosing serious bacterial and bacterial infections in infants and children presenting with fever.

Management of childhood fever by parents: literature review.

Visit

Walsh A, Edwards H.

This paper reports a review which draws together findings from studies targeting parents' temperature-taking, antipyretic administration, attitudes, practices and information-seeking behaviours.

Evaluation and management of infants and young children with fever.

Visit

Luszczak M.

A practice guideline for the management of febrile infants and children younger than three years of age sparked controversy when it was published in 1993. Surveys indicate that many office-based physicians do not agree with recommendations for venipuncture and bladder catheterization in nontoxic febrile children, and that many employ watchful waiting rather than empiric antibiotic therapy. Surveys of parents note a preference for less testing and treatment.

Systematic Review: Temperature measured at the axilla compared with rectum in children and young people: systematic review

Visit

Craig JV, Lancaster GA, Williamson PR, Smyth RL

The objective of this systematic review was to evaluate the agreement between temperature measured at the axilla and rectum in children and young people.

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