Use of the Theoretical Domains Framework to Investigate Factors Influencing Pediatric Fever Management Practices and Antipyretic Use in Australian Emergency Departments

OBJECTIVES: To examine the factors influencing paediatric fever management practices among Australian Emergency Department (ED) doctors and nurses using the Theoretical Domains Framework (TDF). METHODS: Cross-sectional survey of doctors and nurses across 22 Australian EDs. The survey assessed 8 of the 12 domains from the TDF using 13 questionnaire items. RESULTS: A total of 472 participants [275 (58.3%) doctors, 197 (41.7%) nurses] completed the survey (overall response rate 57.7%). Of these, 286/470 (60.9%, 95% CI: 56.4%-65.2%) were familiar with clinical practice recommendations on antipyretic administration for paediatric fever (TDF domain: Knowledge). Similar proportions indicated they had been trained to ensure antipyretic use solely when febrile children appear distressed [TDF domain: Skills; 285/469 (60.8%, 95% CI: 56.3%-65.1%)] and agreed that only administering antipyretics to febrile children who seemed distressed aligned with their professional responsibilities as ED clinicians [TDF domain: Social/Professional Role and Identity; 294/467 (63.0%, 95% CI: 58.5%-67.2%)]. More than half (268/467, 57.4%, 95% CI: 52.8%-61.8%) of participants felt pressured by parents/caregivers to give antipyretics for fever reduction, irrespective of the child's discomfort level [TDF domain: Social Influences]. Just under one-third of participants (137/470, 29.1%, 95% CI: 25.2%-33.4%) aimed to reduce fever before discharge (TDF domain: Goals). CONCLUSIONS: Overall, ED clinicians showed moderate knowledge, training, and agreement with clinical practice recommendations on antipyretic administration for paediatric fever. Notably, more than half of the respondents surveyed felt pressured by parents/caregivers to use antipyretics outside of guideline recommendations. Our findings highlight the significant emotion attached to fever management and the need for clinicians to foster trust and provide tailored evidence-based information to families.