Physical methods

Citation/ElMethodResults
Axelrod208

Study Type:
Review. Evidence level: 1+
Number of People: 2 large RCT

RCT comparing the use of tepid sponge bath with antipyretics alone for young children with temp ≥38.9 °C
The use of tepid sponge bath with antipyretics alone for young children with temp ≥38.9 °C demonstrated unequivocal superiority of drugs for reduction of BT within 2–3 hr of initial treatment. Physical cooling methods are clearly indicated for the treatment of hyperthermia, but their use for the treatment of fever remains controversial because of their propensity to induce cutaneous vasoconstriction.
Drugs tended to work more slowly than tepid sponging.
Cooling
ReferenceNAge, yInitial temp (°C)Antipyretic drugFirst 30 minOverallIncreased discomfort
Aksoylar2822240.5–5RT≥ 39As, P, IBest with spongingBest with drug (3ºc different at 3 h)Not ascertained
Agbolasu283800.5–4.5AT39.5–40PSponging equivalentBest with drug (1.5ºc different at 2 h)No ( qualitative)
Studies in randomised studies: comparisons of the use of sponging plus administration of drugs with drugs alone.
Cooling
ReferenceNAge, yInitial temp (°C)Antipyretic drugFirst 30 minOverallIncreased discomfort
321150.5–5≥39.4ACombination superiorCombination superior: Sponging with ice water or alc & H2O superior to sponging to tepid waterSponging with ice water or alc & H2O was more uncomfortable
33370.5–5≥39.5As, PNo differenceNo differenceNo
341300.25–2≥39.0As, ANo difference at 50 minNo difference7 children were removed from the study due to shivering.
35540.33–4≥38.9ANo differenceCombination superior at 60 minNo
36260.5–5≥38.5PCombine superiorCombination superior over 4 h, small differenceYes: by parent assessment
37750.5–5≥38.5PCombination superiorCombination superior for time to reach temp < 38C; 10% have fever rebound in combination group 0% in drug group.Yes: mainly crying; 1 child shivered.
38200.5–6≥38.9ACombination superior, 1st hourNo differenceyes

A: Acetaminophen
P: Paracetamol
I: Ibuprofen
As: Aspirin
Purssell209

Study Type: review.
EL: 2+
Number of People: Included 4 studies The effect of tepid sponging alongside with paracetamol s. Outcome Measures:
Temp reduction, adverse events
The effectiveness of tepid sponging as a treatment alongside paracetamol varies between studies, two studies found them helpful, tow studies found it is of no benefit.
However, even when a positive effect is seen with the addition of sponging to paracetamol, the difference in temperature reduction between those receiving the sponging is small: at one hour, the mean difference in temperature reduction of the three studies reporting this figures was 0.4 °C.

Side effects and tolerability
3 studies reported shivering, and mention of crying.
One study reported pronounced discomfort in one patient receiving sponging, but crying was reported in over half of this group compared with less than 1/10 in the paracetamol group, another study noted that equal numbers of children objected to, and enjoyed the sponging.. The addition of tepid sponging to paracetamol in the treatment of children offers little advantages over the administration of paracetamol alone in most cases Although it might result in a slightly faster fall in temp, this benefit is short lasting.
Paracetamol doseWater tempSponging timeTemp difference
5–10 mg/kgNeutral20 min0.2 °C
15 mg/kg31.1 °C15 min0.8 °C
120 mg (< 1yr)
240 mg (> 1yr)< BT10–20 min0.1 °C
10–15 mg/kg29–30 °CUntil <38 °CNot reported
Meremikwu213

Study Type: SR.
EL: 1++
Aim:
To evaluate the benefits and harms of physical cooling methods used for managing fever in children.
Method:
They searched the Cochrane Infectious Diseases Group's trials register (February 2003), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library Issue 1, 2003), MEDLINE (1966 to February 2003), EMBASE (1988 to November 2002), LILACS (February 2003), CINAHL (1982 to February 2003), Science Citation Index (1981 to February 2003), and reference lists of articles. We also contacted researchers in the field.

Selection criteria: Randomized and quasi-randomized controlled trials comparing physical methods with a drug placebo or no treatment in children with fever of presumed infectious origin. We included studies where children in both groups were given an antipyretic drug.

Data collection and analysis: Two reviewers independently assessed trial methodological quality. One reviewer extracted data and the other checked the data for accuracy. Results were expressed as relative risk with 95% confidence intervals for binary outcomes, and weighted mean difference for continuous data. Main results: Seven trials, involving 467 participants, met the inclusion criteria
. One small trial (n = 30), comparing physical methods with drug placebo, did not demonstrate a difference in the proportion of children without fever by one hour after treatment in a comparison between physical methods alone and drug placebo. In two studies, where all children received an antipyretic drug, physical methods resulted in a higher proportion of children without fever at one hour (n = 125; relative risk 11.76; 95% confidence interval 3.39 to 40.79). In a third study (n = 130), which only reported mean change in temperature, no difference was detected. Mild adverse events (shivering and goose pimples) were more common in the physical methods group (3 trials; relative risk 5.09; 95% confidence interval 1.56 to 16.60). Conclusions: A few small studies demonstrate that tepid sponging helps to reduce fever in children Background: Health workers recommend bathing, sponging, and other physical methods to treat fever in children and to avoid febrile convulsions. We know little about the most effective methods or how these methods compare with commonly used drugs. Objectives: To evaluate the benefits and harms of physical cooling methods used for managing fever in children. Search strategy: We searched the Cochrane Infectious Diseases Group's trials register (February 2003), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library Issue 1, 2003), MEDLINE (1966 to February 2003), EMBASE (1988 to November 2002), LILACS (February 2003), CINAHL (1982 to February 2003), Science Citation Index (1981 to February 2003), and reference lists of articles. We also contacted researchers in the field. Selection criteria: Randomized and quasi-randomized controlled trials comparing physical methods with a drug placebo or no treatment in children with fever of presumed infectious origin. We included studies where children in both groups were given an antipyretic drug. Data collection and analysis: Two reviewers independently assessed trial methodological quality. One reviewer extracted data and the other checked the data for accuracy. Results were expressed as relative risk with 95% confidence intervals for binary outcomes, and weighted mean difference for continuous data. Main results: Seven trials, involving 467 participants, met the inclusion criteria. One small trial (n = 30), comparing physical methods with drug placebo, did not demonstrate a difference in the proportion of children without fever by one hour after treatment in a comparison between physical methods alone and drug placebo. In two studies, where all children received an antipyretic drug, physical methods resulted in a higher proportion of children without fever at one hour (n = 125; relative risk 11.76; 95% confidence interval 3.39 to 40.79). In a third study (n = 130), which only reported mean change in temperature, no difference was detected. Mild adverse events (shivering and goose pimples) were more common in the physical methods group (3 trials; relative risk 5.09; 95% confidence interval 1.56 to 16.60). Conclusions: A few small studies demonstrate that tepid sponging helps to reduce fever in children

From: Evidence tables

Cover of Feverish Illness in Children
Feverish Illness in Children: Assessment and Initial Management in Children Younger than 5 Years.
NICE Clinical Guidelines, No. 47.
National Collaborating Centre for Women’s and Children’s Health (UK).
London (UK): RCOG Press; 2007 May.
Copyright © 2007, National Collaborating Centre for Women’s and Children’s Health.

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