Knowledge, attitudes and misconceptions of primary care physicians regarding fever in children: a cross sectional study

Demir and Sekreter Italian Journal of Pediatrics 2012, 38:40 http://www.ijponline.net/content/38/1/40 RESEARCH ITALIAN JOURNAL OF PEDIATRICS Open Access Knowledge, attitudes and misconceptions of primary care physicians regarding fever in children: a cross sectional study Figen Demir1* and Ozgur Sekreter2 Abstract Background: Fever is an extremely common sign in paediatric patients and the most common cause for a child to be taken to the doctor. The literature indicates that physicians and parents have too many misconceptions and conflicting results about fever management. In this study we aim to identify knowledge, attitudes and misconceptions of primary care physicians regarding fever in children. Methods: This cross-sectional study was conducted in April-May 2010 involving primary care physicians (n=80). The physicians were surveyed using a self-administered questionnaire. Descriptive statistics were used. Results: In our study only 10% of the physicians knew that a body temperature of above 37.2°C according to an auxiliary measurement is defined as fever. Only 26.2% of the physicians took into consideration signs and symptoms other than fever to prescribe antipyretics. 85% of the physicians prescribed antipyretics to control fever or prevent complications of fever especially febrile seizures. Most of the physicians (76.3%) in this study reported that the height of fever may be used as an indicator for severe bacterial infection. A great majority of physicians (91.3%) stated that they advised parents to alternate the use of ibuprofen and paracetamol. Conclusions: There were misconceptions about the management and complications of fever. There is a perceived need to improve the recognition, assessment, and management of fever with regards to underlying illnesses in children. Keywords: Children, Fever, Physician attitudes Background Fever is an extremely common sign in paediatric patients and the most common cause for a child to be taken to the doctor [1]. Fever in children less than five years of age can be a diagnostic challenge for primary care physicians and even for paediatricians, because it is often difficult to identify the cause. In most cases, fever is due to a self-limiting viral infection including acute upper respiratory infection, however, it may also be the presenting feature of serious bacterial infections such as meningitis or pneumonia, fortunately this represents a minority of cases [2]. In these cases fever is considered a beneficial part of the immune response [3,4]. More * Correspondence: 1 Department of Public Health, Acıbadem University School of Medicine, Gülsuyu Mah. Fevzi Çakmak Cad. Divan Sok. No: 1, Maltepe/İSTANBUL 34848, Turkey Full list of author information is available at the end of the article recent studies have shown that a significant number of children (around 48%) show no obvious cause of fever despite careful assessment [5]. Paediatricians recommend the natural way and/or prescribe medication to lower the fever. This paediatric policy is not intended to quicken recovery but to ensure the comfort of the child [6]. Actually there are only a few reasons for using the antipyretic therapy mentioned above [3,4]. For more than three decades the beneficial effects of mild fever have been known [7]. In 1980 Schmitt discussed parental misconceptions and fear of fever and defined this fear as fever phobia [7]. Physicians contribute to this fever phobia by their incomplete and insensible messages to parents. May and Baucher published a study conforming to the problem of misinformation about fever. This study set forth that instructions given to parents about fever are often inaccurate and physicians also have some © 2012 Demir and Sekreter; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Demir and Sekreter Italian Journal of Pediatrics 2012, 38:40 http://www.ijponline.net/content/38/1/40 misconceptions about fever and its complications. Most of the primary care physicians and even paediatricians believed that fever is dangerous and cause brain damage and febrile convulsions [8]. Although fever has beneficial effects and is good for the immune response, it seems that the negative perceptions of fever, like fears of febrile seizures and fever phobia, remain unchanged. Physicians continue to reduce low grade fever without other symptoms and recommend various kinds of antipyretics to feverish children despite initial treatment [9,10]. In brief, these misconceptions cause unnecessarily aggressive and inappropriate management of feverish children [7,11-16]. Nevertheless there are also conflicting results about fever management in the literature and these conflicts may also contribute to physicians’ misconceptions. In this study we aim to identify knowledge, attitudes and misconceptions of primary care physicians regarding fever in children. Methods This cross-sectional study was conducted in April-May 2010 involving all primary care physicians working in a province with a population of 600 000. During vaccine distribution, researchers went to each primary health care centre to inform physicians about the study. Data was collected after the purpose of the study was explained to the participants and they were informed that their participation was voluntary. Approval for the study was obtained from the Turkish Ministry of Health Local Health Authority of the province in which the research was carried out. The study participants were all primary care physicians who worked in primary health care facilities during the period of study. A sample was not selected, but there were attempts to contact the whole population. Physicians who were on holiday or ill at home during the period of study were excluded from the study. Two of 82 physicians refused participation (the participation rate was 97.4%). Physicians were surveyed using a self-administered questionnaire. It was comprised primarily of closed ended questions about basic demographic characteristics, working conditions, number of working years and setting of practice, knowledge, attitude and management of fever in children. The data was analyzed using the SPSS 16.0 program and descriptive statistics were used. Results The study included 80 physicians (participation rate 97.4%) with a mean age of 36.5 ± 8.3 and the male–female ratio was 1. The socio-demographic characteristics of the participants are presented in Table 1. Page 2 of 7 Table 1 Demographical Characteristics of Physicians Characteristics Descriptive statistics Female, N (%) 40 (% 50) Age (mean ± sd) 36.5 ± 8.3 Marital status Married n (%) 60 (%75) Single n (%) 20(%25) Participant with children Yes n (%) 52 (%65) No n (%) 28(35%) Duration of working (mean ± sd (...truncated)