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Question 2: Does a failure to respond to antipyretics predict serious illness in children with a fever?
  1. David King
  1. Correspondence to Dr David King, Department of Oncology, Sheffield Children's Hospital NHS Foundation Trust, Western Bank, Sheffield S10 2TH, UK; davidanthonyking{at}gmail.com

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Clinical scenario

You are a senior house officer (SHO) working in a busy district general hospital. A 9-month-old boy is brought in by his parents with a fever of 2 days duration. There is no obvious focus but the child appears well. A urine dipstick is negative. When reviewing the child, the registrar is concerned to learn that the fever has not responded to paracetamol (acetaminophen). You wonder if there is any evidence that a febrile child is more likely to have a serious illness if their fever fails to respond to antipyretics.

Structured question

In children with a fever (population) does a failure to respond to antipyretics (indicator) compared with children who do respond to antipyretics (comparison) increase the likelihood of a serious bacterial illness (outcome)?

Search strategy

Primary search

MEDLINE (1946–March 2013) and EMBASE (1947–March, 2013) using the OVID interface were searched. Search terms were: (Fever AND paracetamol AND bacteraemia); limits were: English language, child (0–18). There were 84 hits of which four studies were relevant. The references of these papers were checked, along with the linked articles, and four further studies were found. A further search of the same databases with the …

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