Survey of management of fever without source in young children in Australasian emergency departments

Abstract

Objective: To document the management of young children with fever without source presenting to emergency departments in Australia and New Zealand, and to document to what extent published guidelines are followed. Method: A questionnaire survey was mailed to Directors of emergency departments. Results: Variation in practice, by a number of measures including age ranges used, threshold temperature, investigations performed, antibiotic use and admission criteria was found. Half the departments did not have written management protocols which correlated with greater variation in practice within a department, compared with those that did have written management protocols. For children 3 to 36 months of age, in three of 23 departments (13%) antibiotics were routinely prescribed for fever without source. Conclusions: Among emergency departments, there is variation in practice in the management of fever without source in infants and young children. Variation within departments is correlated with lack of written management guidelines. Antibiotic use is markedly less than recommended in published guidelines and clinical assessment is emphasized. It is proposed that published guidelines have not been incorporated into routine practice because evidence from clinical trials does not support the guidelines.