Fever assessment in children under five: Are we following the guidelines?

Table 1 Demographic data of pediatric patients with or without fever

Demographic data	Total, n = 136 (100)	Febrile1, n = 36 (26.5)	Afebrile, n = 100 (73.5)	P value
Sex				0.3252
Male	80 (58.8)	24 (66.7)	56 (56)
Female	56 (41.1)	12 (33.3)	44 (44)
Nationality				0.2852
Bahraini	97 (71.3)	23 (63.9)	74 (74)
Non-Bahraini	39 (28.6)	13 (36.1)	26 (26)
Age at presentation (mo)				0.0273
0-3	39 (28.7)	4 (11.1)	35 (35)
> 3-6	8 (5.9)	4 (11.1)	4 (4)
> 6-12	17 (12.5)	5 (13.9)	12 (12)
> 12-36	29 (21.3)	12 (33.3)	17 (17)
> 36-60	43 (31.6)	11 (30.6)	32 (32)
Weight on admission (kg), (n = 124)	8.3 (4.0-13.3)	10.2 (7.3-13.0)	7.1 (3.7-13.3)	0.0344
Anatomical site of temperature measurement, (n = 42)				1.0002
Axillary	40 (95.2)	16 (40)	24 (60)
Rectal	2 (4.8)	1 (50)	1 (50)

¹Included any patient who had a spike in temperature ≥ 38 °C during the first 48 h of admission.

²Fisher’s exact test.

³Pearson’s χ² test.

⁴Mann-Whitney U test.

Boldface indicates a statistically significant difference with P < 0.05. Data are presented as n (%) or median (interquartile range).

Table 2 Proportion of patients with or without fever in relation to disease by body system

Diagnosis	Total, n = 136 (100)	Febrile, n = 36 (26.5)	Afebrile, n = 100 (73.5)	P value1
Gastrointestinal disease	47 (34.6)	8 (22.2)	39 (39.0)	0.101
Respiratory disease	29 (21.3)	11 (30.6)	18 (18.0)	0.154
Hematological disease	14 (10.3)	2 (5.6)	12 (12.0)	0.353
Fever of unknown etiology	9 (6.6)	6 (16.7)	3 (3.0)	0.011
Skin disease	9 (6.6)	1 (2.8)	8 (8.0)	0.444
Central nervous system disease	8 (5.9)	5 (13.9)	3 (3.0)	0.030
Renal disease	8 (5.9)	1 (2.8)	7 (7.0)	0.681
Sepsis	7 (5.1)	0 (0.0)	7 (7.0)	0.189
Musculoskeletal disease	2 (1.5)	1 (2.8)	1 (1.0)	0.461
Others2	3 (2.2)	1 (2.8)	2 (2.0)	1.000

¹Fisher’s exact test.

²Brief resolved unexplained episode (n = 2) and metabolic disease (n = 1).

Boldface indicates a statistically significant difference with P < 0.05. Data are presented as n (%).

Table 3 Distribution of the recorded body temperature and its relation to heart rate and respiratory rate

Parameter	Fever (≥ 38 oC), n = 36 (26.5)	No fever (< 38 oC), n = 100 (73.5)	P value (95%CI)
Temperature (degree Celsius)	38.2 (38.2-38.9)	37 (36.8-37)	< 0.0011
Heart rate (beat per minute)	140 ± 24	126 ± 20	0.001 (5.8-21.9)2
Respiratory rate (breath per minute) (n = 135)	28 (24-34)	33 (24-40)	0.1071

¹Mann-Whiteny U test.

²Student’s t test.

Boldface indicates a statistically significant difference with P < 0.05. Data are presented as median (interquartile range) or mean ± SD.

Table 4 Compliance with The National Institute for Health and Care Excellence guidelines

Criterion1	Compliance
	Minimal (≤ 69%)	Partial (70%-95%)	Full (> 95%)
1: Fever is considered if temperature is 38 degrees Celsius or more	-	Yes	-
2: Do not routinely use oral or rectal routes to measure the body temperature of children 0-5 yr	-	-	Yes
3: In infants under the age of 4 wk, measure the body temperature with an electronic thermometer under the axilla	-	-	Yes
4: In children aged 4 wk to 5 yr, measure the body temperature by one of the following: Electrical thermometer to the axilla, chemical dot thermometer to the axilla, or infra-red tympanic thermometer	-	-	Yes
5: As part of routine assessment of children with fever: Record the heart rate	-	-	Yes
6: As part of routine assessment of children with fever: Record the respiratory rate	-	Yes	-
7: As part of routine assessment of children with fever: Record the capillary refill time	NR	NR	NR
8: Use of antipyretics in children with fever who appear distressed	-	-	Yes
9: In case of febrile patient, the temperature is reassessed 1-2 h after each anti-pyretic intake	Yes	-	-
10: The use of tepid sponging is not recommended for the treatment of fever	NR	NR	NR

¹The National Institute for Health and Care Excellence guideline [NG143]: Fever in under 5s: Assessment and initial management. NR: Not reported.