Published online April 3, 2006
PEDIATRICS Vol. 117 No. 4 April 2006, pp. 1067-1076 (doi:10.1542/10.1542/peds.2005-1865)
This Article
Right arrow Full Text
Right arrow Full Text (PDF)
Right arrow Submit a response
Right arrow Alert me when this article is cited
Right arrow Alert me when eLetters are posted
Right arrow Alert me if a correction is posted
Right arrow Citation Map
Services
Right arrow E-mail this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in ISI Web of Science
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Add to My File Cabinet
Right arrow Download to citation manager
Right arrowRequest Permissions
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via CrossRef
Right arrow Citing Articles via ISI Web of Science (4)
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Madsen, K. A.
Right arrow Articles by Downs, S. M.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Madsen, K. A.
Right arrow Articles by Downs, S. M.
Related Collections
Right arrow Infectious Disease & Immunity
Social Bookmarking
Add to CiteULike   Add to Connotea   Add to Del.icio.us   Add to Digg   Add to Facebook   Add to Reddit   Add to Technorati   Add to Twitter  
What's this?

The Role of Parental Preferences in the Management of Fever Without Source Among 3- to 36-Month-Old Children: A Decision Analysis

Kristine A. Madsen, MD, MPHa, Jonathan E. Bennett, MDb and Stephen M. Downs, MD, MSc

a Department of Pediatrics, University of California, San Francisco, San Francisco, California
b Division of Emergency Medicine, A.I. duPont Hospital for Children, Wilmington, Delaware
c Department of Children's Health Services Research, Indiana University School of Medicine, Indianapolis, Indiana

OBJECTIVES. Recent analyses assessing the impact of the conjugate pneumococcal vaccine on the care of febrile children do not reflect the role parental preferences play in physicians' decisions. The objective of this study was to identify the management strategy that would best suit parents, on the basis of their values for possible outcomes of fever of ≥39°C without source among well-appearing, 3- to 36-month-old children.

METHODS. A decision analysis was performed to compare the benefits and outcomes of 3 management options (treat: blood culture and antibiotics for all children; test: blood culture and complete blood count for all children, with antibiotics for selected children; observe: no immediate intervention). A hypothetical cohort of 100000 children with fever of ≥39°C with no obvious source of infection was modeled for each strategy. Using this model, we identified the treatment option that would best suit each parent's preferences, on the basis of parental utilities (from a prior study) for various interventions and outcomes at vaccine efficacies of 0% (ie, no vaccine) and 95%. In addition, we performed survival analyses to assess the morbidity and mortality rates associated with each treatment strategy at various vaccine efficacies.

RESULTS. At a vaccine efficacy of 0%, the majority of parents' preferences suggested the treat option, the strategy with the lowest mortality rate. At a vaccine efficacy of 95%, mortality rates were similar for all 3 management options (~1 in 100000), but parental preferences were still aligned with different options; 50% suggested observe, 42% suggested test, and 8% suggested treat.

CONCLUSIONS. Like physicians, parents have different approaches to risk. With the conjugate pneumococcal vaccine, risks of complications from fever without source are low regardless of treatment strategy. Rather than having a "one size fits all" approach, it is reasonable to incorporate parental preferences into the treatment decision.

Key Words: child • decision-making • fever of unknown origin • parental attitudes • patient-doctor communication

Abbreviations: WBC—white blood cell

Accepted Sep 26, 2005.


Add to CiteULike CiteULike   Add to Connotea Connotea   Add to Del.icio.us Del.icio.us   Add to Digg Digg   Add to Facebook Facebook   Add to Reddit Reddit   Add to Technorati Technorati   Add to Twitter Twitter    What's this?


This article has been cited by other articles:


Home page
 PediatricsHome page
B. W. Trautner, C. G. Macias, and A. C. Caviness
High Fever: In Reply.
Pediatrics, December 1, 2006; 118(6): 2604a - 2605.
[Full Text] [PDF]