Added Efficacy of Paracetamol in Tepid Sponging for Fever Reduction

Abstract

Objective: Fever is one of the most common presenting symptoms in children receiving care at the outpatient walk-in clinic or emergency room. At the Department of Pediatrics, Faculty of Medicine Siriraj Hospital, detecting and managing febrile children has become a routine practice due, in part, to the implementation of nursing triage. Such measure has brought about a significant reduction in the occurrence of febrile convulsion in the waiting room. However, different nurses employ different or a combination of methods to achieve fever reduction, leading to questions regarding their efficacy in reducing fever in the pediatric outpatient department.
Methods: This is a prospective observational study of children presenting to the outpatient clinic at the Department of Pediatrics, Siriraj Hospital, between January and December 2003. The children were taken to the treatment room if they were found at triage to have body temperature of 38.5oC. There, the nurses are free to administer either tepid sponging alone or in combination with paracetamol syrup 10 mg/kg/dose. A second temperature was taken before they were released into the waiting room. The data regarding their age, initial and follow-up temperatures, time intervals between the two readings, and whether or not they received paracetamol was collected. The data was then stratified into 2 groups: those who received tepid sponging alone (TS alone) and those who received tepid sponging and paracetamol (TS/Para). Data analysis was done using Sigmastatâ„¢2.03. Both two-tailed t-test and a Mann-Whitney Rank Sum Test were employed to analyze the differences between the two groups. Multiple linear regressions were used to correct for the differences that age and time interval between measurements might have on temperature reduction of both groups.
Results: There were 995 children who received fever-reduction measures at the outpatient department over the 12-month period. The TS/Para group achieves a statistically significant lower average body temperature than the TS only group at the end of the treatment period (0.647 ± 0.675 vs. 0.543 ± 0.560; p 0.05) and multiple linear regression analysis shows a statistically significant trend in fever reduction with the TS/Para method when correcting for the effect of patient’s age and time interval between measurements.
Conclusion: From our study, it is shown that the administration of tepid sponging together with paracetamol can reduce more effectively the body temperature than when tepid sponging is employed alone. However, further study is needed to ascertain the sustainability of fever reduction with these two methods and whether paracetamol administration alone, without tepid sponging, can also achieve the same goal in fever reduction.